Introduction: Cytomegalovirus (CMV) infection remains a serious problem in D+/R- kidney transplant patients. Universal prophylaxis with valganciclovir (VGC) for 6 months has been advocated by the various guidelines, though the dosage of VGC used remains a point of debate. In addition, preemptive therapy is a still acceptable alternative. We performed cost effectiveness analysis (CEA) comparing universal prophylaxis using two different VGC dosing regimens and preemptive therapy with intense viremia monitoring.

Materials and Methods: Between October 2005 and December 2011, all D+/R- kidney only transplant patients in our program were given VGC 450 mg daily for 180 days post-transplantation with one-time CMV viremia measurement at the completion of 180 days (UP1). The incidence of CMV infection, symptomatic and/or asymptomatic was assessed. The incidence of CMV infection among D+/R- kidney transplant patients receiving valganciclovir 900 mg daily for 200 days post-transplantation (UP2), and those receiving preemptive therapy (PE) were obtained from the published literature. Standardized decision tree analysis with Markov transition model was utilized.

Results: Of 204 D+/R- kidney transplant patients receiving VGC 450 mg daily for 180 days (UP1), 24 (16.7%) and 13 (6.4%) were diagnosed symptomatic and asymptomatic CMV infection, respectively. The incidence of symptomatic and asymptomatic CMV infection among patients receiving 900 mg VGC daily for 200 days (UP2) and among patients receiving preemptive therapy (PE) was 21.3% and 0%, 31.6% and 33.5%, respectively. The cost, direct and total, and quality-adjusted life years (QALYs) gained from each strategy are shown here.

Compared to preemptive therapy, two universal prophylaxis strategies spent $3,300 and $29,212 more per infection avoided, and $9,302 and $122,379 more per disease avoided in direct cost, respectively. Over the 10-years time horizon, however, both universal prophylaxis strategies will result in money saving per infection and disease avoided. Furthermore both universal prophylaxis strategies result in a net gain on QALYs.

Conclusion: Universal prophylaxis is cost saving and results in improved quality-adjusted life years.

« Back to 2013 American Transplant Congress