Date: Monday, June 3, 2019
Session Name: Concurrent Session: Breakthroughs in Cytomegalovirus
Session Time: 4:30pm-6:00pm
Presentation Time: 5:42pm-5:54pm
Location: Ballroom A
*Purpose: To compare the cost effectiveness of preemptive therapy (PET) vs prophylaxis for the prevention of cytomegalovirus (CMV) in high-risk donor seropositive/recipient seronegative (D+R-) liver transplant.
*Methods: In a NIH-funded randomized, multicenter trial, 205 D+R- liver transplant recipients received valganciclovir as PET upon detection of CMV viremia (on weekly monitoring for 100 days) or as prophylaxis for 100 days. A decision tree analytic model was constructed based on the probability of outcomes in this trial. Efficacy assessments included cost of CMV surveillance, antiviral drug, diagnostic procedures, treatment of neutropenia, hospitalizations and mortality until 12 months post-transplant. Costs were obtained from a National database (Healthcare Costs and Utilization Project, HCUP-US.ahrq.gov) and Medicare payment data. One and 2-way sensitivity analyses were performed.
*Results: The incidence of CMV disease (adjudicated by an independent end-point committee) was 9% in PET vs 19% in the prophylaxis group (p=0.039). The difference was due largely to significantly less post-prophylaxis disease (CMV disease after 100 days) in PET (6%) vs prophylaxis (17%) group. Mortality, graft loss and rejection did not differ for two groups (p>0.05 for all). Hospitalizations, including ICU admissions were required in 79% of patients with CMV disease, with average length of stay (LOS) of 14 days. Prophylaxis patients with CMV disease had significantly longer LOS than patients with CMV disease in PET group (p<.001). Despite the cost of monitoring for viremia, PET resulted in incremental savings of ~$8,400 per study patient. PET remained the dominant preventive strategy even when the cost of CMV disease management was increased or decreased by 40%. Only if the incidence of CMV disease in the prophylaxis group decreased to less than 12%, did cost effectiveness shift from PET to prophylaxis.
*Conclusions: PET is a more cost effective strategy than prophylaxis for the prevention of CMV disease in D+R- liver transplant recipient. Costs were driven by more hospitalizations and higher treatment costs associated with CMV disease in the post-prophylaxis period.
To cite this abstract in AMA style:Wagener MM, Winston DJ, Razonable RR, III GMLyon, Silveira FP, Limaye AP, Singh N. Preemptive Therapy is Cost Effective When Compared to Prophylaxis in Cytomegalovirus Donor Positive – Recipient Negative Liver Transplant Recipients [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/preemptive-therapy-is-cost-effective-when-compared-to-prophylaxis-in-cytomegalovirus-donor-positive-recipient-negative-liver-transplant-recipients/. Accessed December 3, 2020.
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