Legendre Christophe, Beard Stephen M, Crochard Anne, Lebranchu Yvon, Pouteil-Noble Claire, Richter Anke, Durand-Zaleski Isabelle
St. Louis Hospital, Paris, France.
Eur J Health Econ. 2005 Jun;6(2):172-82. doi: 10.1007/s10198-004-0275-9.
Prophylaxis-based antiviral treatment and intensive monitoring followed by pre-emptive antiviral treatment are both commonly used management strategies to reduce risk of cytomegalovirus (CMV) infection following renal transplantation. This study employed a decision-model approach using published efficacy data and information from a recent survey of French clinical practice to consider the relative costs and outcomes associated with CMV prevention strategies for high-risk patient groups. The cost per case of treating tissue invasive and symptomatic CMV disease was estimated at euro 15,431 and euro 10,852, respectively. In the highest infection-risk patient group (positive donor with no previous CMV history) prophylactic oral valaciclovir was shown to avoid the greatest number of CMV disease cases (35 cases per 100 transplanted patients) and reduced the overall CMV-related costs per transplanted patient by around 14% over a'wait-and-treat' baseline strategy. In contrast, intensive monitoring and preemptive treatment resulted in a much higher cost per transplanted patient. This analysis suggests that prophylactic treatment remains the most cost-effective approach to the management of CMV in renal-transplanted patients. Further comparative studies between prophylactic and pre-emptive treatment would be a valuable addition to the current evidence based on CMV prevention.
基于预防的抗病毒治疗以及随后进行抢先抗病毒治疗的强化监测，都是肾移植后降低巨细胞病毒（CMV）感染风险常用的管理策略。本研究采用决策模型方法，利用已发表的疗效数据以及来自法国近期临床实践调查的信息，来考量高危患者群体CMV预防策略的相关成本和结果。治疗组织侵袭性和有症状CMV疾病的每例成本估计分别为15431欧元和10852欧元。在感染风险最高的患者群体（供体阳性且既往无CMV病史）中，预防性口服伐昔洛韦可避免最多的CMV疾病病例（每100例移植患者中有35例），并且与“等待并治疗”的基线策略相比，可使每位移植患者的总体CMV相关成本降低约14%。相比之下，强化监测和抢先治疗导致每位移植患者的成本要高得多。该分析表明，预防性治疗仍然是肾移植患者CMV管理中最具成本效益的方法。预防性治疗和抢先治疗之间的进一步比较研究将是对当前基于CMV预防的证据的宝贵补充。
