Legendre C M, Norman D J, Keating M R, Maclaine G D, Grant D M
Service de Transplantation Rénale, Hospital Saint Louis, Paris, France.
Transplantation. 2000 Nov 27;70(10):1463-8. doi: 10.1097/00007890-200011270-00012.
Cytomegalovirus (CMV) disease is a major cause of morbidity and mortality in solid organ transplant patients and is associated with large additional healthcare expenditures. An economic evaluation of valaciclovir CMV prophylaxis in a renal transplant population is reported.
Medical resource use data were collected alongside a multicenter multinational randomized, placebo-controlled, double-blind trial of valaciclovir CMV prophylaxis in renal transplantation. Patients were stratified into donor seropositive/recipient sero-negative (D+R-) and recipient seropositive (R+) groups. Patients were followed-up 6 months posttransplant. A cost-effectiveness analysis from the perspective of the French health care system was performed using the number of cases of CMV disease avoided at 6 months as the clinical endpoint.
Resource use was significantly increased among patients who developed CMV disease compared to those who did not develop disease. In the high risk D+R- group, valaciclovir prophylaxis was associated with an average of 5.5 fewer inpatient hospital days (P < OR =0.05) and with significantly lower use of other healthcare resources. In the R+ group, valaciclovir prophylaxis prevented cases of CMV disease at a marginally greater mean cost per patient compared with placebo. For D+R- patients valaciclovir prophylaxis was therefore an economically superior strategy, resulting in fewer cases of CMV disease and lower total mean healthcare expenditures.
Valaciclovir CMV prophylaxis in renal transplantation is a more cost-effective therapy compared with placebo, in the high-risk D+R- patient population. For the R+ group, the incremental cost per case of CMV disease was modest.
巨细胞病毒（CMV）疾病是实体器官移植患者发病和死亡的主要原因，且与大量额外的医疗保健支出相关。本文报告了一项针对肾移植人群使用伐昔洛韦预防CMV的经济学评估。
在一项多中心、多国、随机、安慰剂对照、双盲的肾移植伐昔洛韦预防CMV试验中，收集了医疗资源使用数据。患者被分为供体血清阳性/受体血清阴性（D+R-）组和受体血清阳性（R+）组。对患者进行移植后6个月的随访。以6个月时避免发生的CMV疾病病例数作为临床终点，从法国医疗保健系统的角度进行了成本效益分析。
与未发生CMV疾病的患者相比，发生CMV疾病的患者资源使用显著增加。在高风险的D+R-组中，伐昔洛韦预防与平均减少5.5个住院日相关（P<或=0.05），且其他医疗资源的使用也显著降低。在R+组中，与安慰剂相比，伐昔洛韦预防CMV疾病的平均成本略高。因此，对于D+R-患者，伐昔洛韦预防是一种经济上更优的策略，可减少CMV疾病病例数并降低总平均医疗保健支出。
在高风险的D+R-患者群体中，肾移植中使用伐昔洛韦预防CMV与安慰剂相比是一种更具成本效益的治疗方法。对于R+组，每例CMV疾病的增量成本适中。
