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This Article Full Text Full Text (PDF) Press Release All Versions of this Article: ASN.2008111166v1 20/11/2449    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Luan, F. L. Articles by Ojo, A. PubMed PubMed Citation Articles by Luan, F. L. Articles by Ojo, A.

Six-Month Prophylaxis Is Cost Effective in Transplant Patients at High Risk for Cytomegalovirus Infection

Fu L. Luan^*, Linda J. Stuckey, Jeong M. Park, Daniel Kaul, Diane Cibrik^* and Akinlolu Ojo^*

*Internal Medicine, Division of Nephrology;
College of Pharmacy and Department of Pharmacy Service; and
Internal Medicine, Division of Infectious Disease, University of Michigan, Ann Arbor, Michigan

Correspondence: Dr. Fu L. Luan, 3914 Taubman Center, Box 0364, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0364. Phone: 734-763-0990; Fax: 734-936-9621; E-mail: fluan{at}med.umich.edu

Received for publication November 13, 2008. Accepted for publication July 6, 2009.

The risk of late-onset cytomegalovirus (CMV) infection remains a concern in seronegative kidney and/or pancreas transplant recipients of seropositive organs despite the use of antiviral prophylaxis. The optimal duration of prophylaxis is unknown. We studied the cost effectiveness of 6- versus 3-mo prophylaxis with valganciclovir. A total of 222 seronegative recipients of seropositive kidney and/or pancreas transplants received valganciclovir prophylaxis for either 3 or 6 mo during two consecutive time periods. We assessed the incidence of CMV infection and disease 12 mo after completion of prophylaxis and performed cost-effectiveness analyses. The overall incidence of CMV infection and disease was 26.7% and 24.4% in the 3-mo group and 20.9% and 12.1% in the 6-mo group, respectively. Six-month prophylaxis was associated with a statistically significant reduction in risk for CMV disease (HR, 0.35; 95% CI, 0.17 to 0.72), but not infection (HR, 0.65; 95% CI, 0.37 to 1.14). Cost-effectiveness analyses showed that 6-mo prophylaxis combined with a one-time viremia determination at the end of the prophylaxis period incurred an incremental cost of $34,362 and $16,215 per case of infection and disease avoided, respectively, and $8,304 per one quality adjusted life-year gained. Sensitivity analyses supported the cost effectiveness of 6-mo prophylaxis over a wide range of valganciclovir and hospital costs, as well as variation in the incidence of CMV disease. In summary, 6-mo prophylaxis with valganciclovir combined with a one-time determination of viremia is cost effective in reducing CMV infection and disease in seronegative recipients of seropositive kidney and/or pancreas transplants.

Copyright © 2009 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673