Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
Transplantation. 2010 Dec 27;90(12):1420-6. doi: 10.1097/TP.0b013e3181ff500d.
Cytomegalovirus (CMV) disease in transplant patients is known to have a substantial clinical and economic burden, and its prevention is expected to have long-term benefits. Evidence from the Improved Protection Against CMV in Transplant trial proved that prolonged prophylaxis of 200 days with valganciclovir compared with 100 days significantly reduces the incidence of CMV in high-risk kidney transplant seropositive donors/seronegative recipients. The aim of this study was to develop a cost-effectiveness model to evaluate prolonged prophylaxis of 200 days with valganciclovir and its long-term economic impact.
An economic model was designed to simulate long-term costs and outcomes of prolonged prophylaxis with valganciclovir (200 vs. 100 days) in a cohort of 10,000 high-risk renal transplant patients over 5 and 10 years. The first year of the model was based on the results of the Improved Protection Against CMV in Transplant trial and the extension to the long-term periods (5 and 10 years); and quality of life data were based on evidence retrieved through a systematic literature search. This analysis was conducted from the US healthcare payer perspective.
For the 5-year time horizon, the incremental cost-effectiveness ratio of US $14,859/quality-adjusted life year (QALY) suggests that 200-day valganciclovir prophylaxis is cost effective over the 100-day regimen considering a threshold of US $50,000/QALY. The 10-year analysis revealed the 200-day prophylaxis as cost saving with a 2380 QALY gain and simultaneously lower cost.
Prolonged prophylaxis with valganciclovir reduces the incidence of events associated with CMV infection in high-risk kidney transplant recipients and is a cost-effective strategy in CMV disease management.
移植患者的巨细胞病毒（CMV）疾病已知具有重大的临床和经济负担，其预防有望带来长期效益。来自“改善移植中 CMV 保护”试验的证据证明，与 100 天相比，用缬更昔洛韦进行 200 天的延长预防可显著降低高危肾移植血清阳性供体/血清阴性受者的 CMV 发生率。本研究旨在开发一种成本效益模型，以评估缬更昔洛韦延长预防 200 天的效果及其长期经济影响。
设计了一种经济模型，以模拟 10000 例高危肾移植患者在 5 年和 10 年内延长预防（200 天与 100 天）的长期成本和结果。模型的第一年基于“改善移植中 CMV 保护”试验的结果和长期（5 年和 10 年）的扩展；以及基于系统文献检索中获得的证据的生活质量数据。本分析从美国医疗保健支付者的角度进行。
在 5 年的时间范围内，200 天缬更昔洛韦预防方案的增量成本效益比为每质量调整生命年（QALY）14859 美元，这表明考虑到 50000 美元/QALY 的阈值，200 天缬更昔洛韦预防方案在 100 天方案的基础上具有成本效益。10 年分析显示，200 天的预防方案具有成本效益，可获得 2380 个 QALY 增益，同时降低成本。
延长缬更昔洛韦预防可降低高危肾移植受者 CMV 感染相关事件的发生率，是 CMV 疾病管理的一种具有成本效益的策略。
