title: Valganciclovir versus valacyclovir prophylaxis for prevention of cytomegalovirus: an economic perspective.
abstract: BACKGROUND
  Valganciclovir (vGCV) and valacyclovir (vACV) are used in cytomegalovirus (CMV) prophylaxis in renal transplant recipients. The aim of this study was to compare the economic impact of both regimens during 1-year follow-up.
  
  
  METHODS
  A total of 117 renal transplant recipients at risk for CMV were randomized to 3-month prophylaxis either with vGCV (900 mg/day, n = 60) or vACV (8 g/day, n = 57) and their data used in a pharmacoeconomic analysis. The pharmacoeconomic evaluation involved all direct CMV-related expenses in the first year after transplantation. Sensitivity analysis was employed to examine the effects of various prices of antiviral drugs and diagnostic procedures on overall CMV-related costs. Simulation of the more expensive US healthcare perspective was performed, and a scenario involving costs of acute rejection (AR) was examined.
  
  
  RESULTS
  Overall CMV-related costs were significantly lower in the vACV arm; median United States dollars (USD) 3473 (3108-3745) vs. USD 5810 (4409-6757; P < 0.001) per patient, respectively. Our data showed that the critical determinant of the major disparity between the prophylactic regimens was the prophylaxis price. Median cost of prophylaxis in the vACV group was USD 1729 (1527-2173) compared to USD 3968 (2683-4857) in the vGCV group (P < 0.001). In sensitivity analysis of the overall CMV-related costs, the least and the most expensive pharmacotherapy and diagnostic scenarios were used; nevertheless, the vACV arm remained markedly less expensive. Simulation considering the higher physician/nurse and hospitalization fees of the US healthcare system and the scenario including expenditure associated with AR episodes also favored vACV.
  
  
  CONCLUSIONS
  VACV prophylaxis for CMV is associated with a significant 44% lower cost than vGCV at the first year after renal transplantation.
authors.affiliation: Department of Internal Medicine I, Charles University Medical School and Teaching Hospital, Pilsen, Czech Republic.|Biomedical Center, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic.
authors.forename: M
authors.initials: M
authors.lastname: Kacer
authors.affiliation: Department of Internal Medicine I, Charles University Medical School and Teaching Hospital, Pilsen, Czech Republic.|Biomedical Center, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic.
authors.forename: L
authors.initials: L
authors.lastname: Kielberger
authors.affiliation: Department of Internal Medicine I, Charles University Medical School and Teaching Hospital, Pilsen, Czech Republic.|Biomedical Center, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic.
authors.forename: M
authors.initials: M
authors.lastname: Bouda
authors.affiliation: Department of Internal Medicine I, Charles University Medical School and Teaching Hospital, Pilsen, Czech Republic.|Biomedical Center, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic.
authors.forename: T
authors.initials: T
authors.lastname: Reischig
mesh_terms: D000212:Acyclovir / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000191:economics*; D003587:Cytomegalovirus / Q000187:drug effects*; D003586:Cytomegalovirus Infections / Q000191:economics* / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D015774:Ganciclovir / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics* / Q000517:prevention & control; D000077483:Valacyclovir; D000077562:Valganciclovir; D014633:Valine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics
chemical_list: D000998:Antiviral Agents; D000077562:Valganciclovir; D014633:Valine; D000077483:Valacyclovir; D015774:Ganciclovir; D000212:Acyclovir
keywords: cost; cytomegalovirus; economic; prevention; renal transplantation; valacyclovir; valganciclovir