title: Cost-effectiveness of cidofovir treatment of polyomavirus nephropathy in kidney transplant recipients.
abstract: BACKGROUND
  BK virus nephropathy (BKVAN) causes about 10% of late kidney graft loss. Cidofovir is widely used to treat BKVAN, but the magnitude of the health benefits and costs are largely unknown. We aimed to evaluate the incremental health benefits and costs of cidofovir and immunosuppression reduction compared with immunosuppression reduction alone in kidney transplant patients with BKVAN.
  
  
  METHODS
  A probabilistic decision analytic model was developed to simulate a cohort of kidney transplant recipients aged 45 years and above with BKVAN who received cidofovir treatment compared with those who received standard care. The duration of the cycle was 1 year, and the model terminated when all recipients were deceased.
  
  
  RESULTS
  Compared with immunosuppression reduction alone, in the base-case, the incremental health benefits of cidofovir were 0.0061 life-years saved (2.2 days), with savings of $20,756 over the lifetime of a transplant recipient. When varying the most influential variables (the probability of response to treatment and graft loss) between best and worst case scenarios, the incremental health outcomes ranged from -0.967 to 1.093 life-years saved, with incremental costs ranging from an extra $27,313 to saving $20,756.
  
  
  CONCLUSIONS
  Compared with immunosuppression reduction alone, based on best available data, cidofovir treatment and immunosuppression reduction for BKVAN seem to be cost saving and improves health outcomes. However, because of weak clinical data, particularly around comparative effectiveness, there is still moderate uncertainty in the incremental cost effectiveness. Adequately powered trials are still needed to better define optimal treatment strategies for BKVAN before cidofovir can be recommended strongly as routine therapy.
authors.affiliation: Centre for Kidney Research, Children's Hospital at Westmead, Australia.
authors.forename: Danny K
authors.initials: DK
authors.lastname: Hua
authors.forename: Kirsten
authors.initials: K
authors.lastname: Howard
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Chapman
authors.forename: Germaine
authors.initials: G
authors.lastname: Wong
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D001739:BK Virus; D000077404:Cidofovir; D003362:Cost-Benefit Analysis; D003596:Cytosine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D003661:Decision Support Techniques; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000191:economics; D007674:Kidney Diseases / Q000188:drug therapy* / Q000191:economics / Q000209:etiology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D015233:Models, Statistical; D063065:Organophosphonates / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D027601:Polyomavirus Infections / Q000188:drug therapy* / Q000191:economics / Q000209:etiology; D014412:Tumor Virus Infections / Q000188:drug therapy* / Q000191:economics / Q000209:etiology
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D063065:Organophosphonates; D003596:Cytosine; D000077404:Cidofovir