Six-Month Prophylaxis Is Cost Effective in Transplant Patients at High Risk for Cytomegalovirus Infection
Six-Month Prophylaxis Is Cost Effective in Transplant Patients at High Risk for Cytomegalovirus Infection
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DOI：
10.1681/asn.2008111166
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发表时间：
2009-11-01
影响因子：
13.6
通讯作者：
Ojo, Akinlolu
中科院分区：
文献类型：
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作者：
Luan, Fu L.;Stuckey, Linda J.;Ojo, Akinlolu
尽管使用了抗病毒预防措施，但血清阴性肾和/或胰腺移植血清阳性器官的受者仍担心迟发性巨细胞病毒（CMV）感染的风险。预防的最佳持续时间尚不清楚。我们研究了缬更昔洛韦 6 个月与 3 个月预防的成本效益。总共 222 名血清反应呈阳性的肾和/或胰腺移植受者在连续两个时间段内接受了 3 或 6 个月的缬更昔洛韦预防。我们在预防完成后 12 个月评估了 CMV 感染和疾病的发生率，并进行了成本效益分析。 3 个月组中 CMV 感染和疾病的总体发生率分别为 26.7% 和 24.4%，6 个月组中分别为 20.9% 和 12.1%。六个月的预防与 CMV 疾病风险的统计学显着降低相关（HR，0.35；95% Cl，0.17 至 0.72），但与感染风险无关（HR，0.65；95% Cl，0.37 至 1.14）。成本效益分析表明，6 个月的预防与预防期结束时的一次性病毒血症测定相结合，每避免一例感染和疾病，分别产生 34,362 美元和 16,215 美元的增量成本，每增加一个质量调整生命年，产生 8,304 美元的增量成本。敏感性分析支持 6 个月预防治疗在各种缬更昔洛韦和住院费用以及 CMV 疾病发病率变化方面的成本效益。总之，对于血清阳性肾和/或胰腺移植的血清阴性受者来说，使用缬更昔洛韦进行 6 个月预防结合一次性测定病毒血症对于减少 CMV 感染和疾病具有成本效益。
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% Cl, 0.17 to 0.72), but not infection (HR, 0.65; 95% Cl, 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.