Cost of prophylaxis in the management of cytomegalovirus infection in solid organ transplant recipients.
BACKGROUND
Limited economic data exist on the use of valganciclovir for the prevention of cytomegalovirus (CMV) infection and disease in solid organ transplant (SOT) recipients. We compared the economics of sequential i.v. and oral ganciclovir prophylaxis vs. oral valganciclovir prophylaxis alone in high-risk (D+/R-) SOT patients.


METHODS
A cost-minimization analysis was performed from the perspective of the Spanish National Health System comparing the cost of sequential ganciclovir prophylaxis (induction with i.v. ganciclovir 10 mg/kg daily for 14 d followed by oral ganciclovir 1 g t.i.d. for 3 months) vs. oral valganciclovir prophylaxis (900 mg once daily for 100 d). Resource utilization data for both regimens were obtained from the literature and from clinical records of 83 patients in nine Spanish hospitals. Results were expressed as average cost per patient treated.


RESULTS
The average cost per patient treated with sequential ganciclovir or valganciclovir prophylaxis was euro3715.51 and euro3295.90, respectively. The higher cost of ganciclovir therapy was due to concomitant administration of anti-CMV immunoglobulin (euro313.73), drug administration costs (euro401.45), catheter culture tests (euro13.64) and adverse events associated with catheter use (euro3.30). Following a sensitivity analysis, taking into account dose and duration of drug, concomitant medications and adverse events, costs for valganciclovir and sequential therapy were similar.


CONCLUSIONS
Valganciclovir prophylaxis is as economical as sequential ganciclovir prophylaxis in high-risk D+/R- SOT patients. In addition, the once-daily dosing regimen of valganciclovir is more convenient, and avoids the complications associated with catheter use.
Oppenheimer
Federico
F
Hospital Clínic i Provincial de Barcelona, Barcelona, Spain. oppen@clinic.ub.es
Gonzalez-Molina
Miguel
M
Rubio
Marta
M
D000284:Administration, Oral; D019072:Antibiotic Prophylaxis / Q000191:economics*; D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D003587:Cytomegalovirus / Q000187:drug effects*; D003586:Cytomegalovirus Infections / Q000191:economics* / Q000517:prevention & control; D016527:Drug Costs; D015774:Ganciclovir / Q000031:analogs & derivatives* / Q000191:economics* / Q000627:therapeutic use; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007262:Infusions, Intravenous; D016377:Organ Transplantation; D011183:Postoperative Complications / Q000191:economics; D013997:Time Factors; D000077562:Valganciclovir
D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir