Purpose: To assess cost-effectiveness(CE) of screening for CMV after 6 months of valganciclovir prophylaxis in CMV high-risk (D+R-) kidney transplant recipients.

Methods: A Markov model was used to estimate CE of 3 CMV screening strategies [weekly(Qwk), every 2 weeks(Q2wk) and every 4 weeks(Q4wk)] compared with no screening, in reducing CMV related hospitalizations, graft and patient loss. The model was based on screening for 6 months post-prophylaxis and treating all viremias. Costs, utilities and probabilities were derived from published reports as available. CMV severity was assumed to be proportional to the viremia level; the probability of progression to symptomatic CMV was modelled on CMV replication kinetics.

Results

Table 1 shows the results of base case CE analysis for the four strategies.

In sensitivity analysis, a <10% incidence of CMV between 6-12 months or CMV PCR cost >$130 increased the cost of Q2wk screen to >$20,000/QALY gained. Q2wk strategy cost $36,498/QALY gained when no increased death or dialysis was attributed to CMV. In probabilistic analysis, Q2wk strategy was cost-effective in 70% and 93% of the model iterations with an acceptability threshold of $20,000 and $50,000 respectively. Q2wk was less cost-effective than Qwk strategy when acceptability threshold was >$156,000(Figure 1)

Conclusion: In high-risk (D+R-) CMV kidney transplant recipients, post-prophylactic screening with CMV PCR every 2 weeks is more cost-effective than no screening or screening at weekly or every 4 week intervals.

CITATION INFORMATION: Puttarajappa C, Hariharan S, Smith K. Cost Effectiveness of Post-Prophylaxis Screening Strategies for Cytomegalovirus Viremia in CMV D+R- Kidney Transplant Recipients. Am J Transplant. 2017;17 (suppl 3).

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