Centre for Kidney Research, Children's Hospital at Westmead, Australia.
Transplantation. 2012 Jan 27;93(2):188-94. doi: 10.1097/TP.0b013e31823e7b0e.
BK virus nephropathy (BKVAN) causes about 10% of late kidney graft loss. Cidofovir is widely used to treat BKVAN, but the magnitude of the health benefits and costs are largely unknown. We aimed to evaluate the incremental health benefits and costs of cidofovir and immunosuppression reduction compared with immunosuppression reduction alone in kidney transplant patients with BKVAN.
A probabilistic decision analytic model was developed to simulate a cohort of kidney transplant recipients aged 45 years and above with BKVAN who received cidofovir treatment compared with those who received standard care. The duration of the cycle was 1 year, and the model terminated when all recipients were deceased.
Compared with immunosuppression reduction alone, in the base-case, the incremental health benefits of cidofovir were 0.0061 life-years saved (2.2 days), with savings of $20,756 over the lifetime of a transplant recipient. When varying the most influential variables (the probability of response to treatment and graft loss) between best and worst case scenarios, the incremental health outcomes ranged from -0.967 to 1.093 life-years saved, with incremental costs ranging from an extra $27,313 to saving $20,756.
Compared with immunosuppression reduction alone, based on best available data, cidofovir treatment and immunosuppression reduction for BKVAN seem to be cost saving and improves health outcomes. However, because of weak clinical data, particularly around comparative effectiveness, there is still moderate uncertainty in the incremental cost effectiveness. Adequately powered trials are still needed to better define optimal treatment strategies for BKVAN before cidofovir can be recommended strongly as routine therapy.
BK 病毒肾病（BKVAN）导致约 10%的晚期肾脏移植物丢失。更昔洛韦广泛用于治疗 BKVAN，但健康获益和成本的大小在很大程度上尚不清楚。我们旨在评估与单独减少免疫抑制相比，西多福韦治疗 BKVAN 肾移植患者的增量健康获益和成本。
开发了一个概率决策分析模型，以模拟一组年龄在 45 岁及以上、患有 BKVAN 的接受西多福韦治疗的肾移植受者与接受标准护理的受者相比的队列。周期持续时间为 1 年，当所有受者死亡时模型终止。
与单独减少免疫抑制相比，在基础情况下，西多福韦的增量健康获益为 0.0061 个生命年（2.2 天），在受者的一生中节省了 20756 美元。当在最佳和最差情况之间变化最具影响力的变量（治疗反应的概率和移植物丢失）时，增量健康结果的范围从 -0.967 到 1.093 个生命年，增量成本从额外的 27313 美元到节省 20756 美元。
与单独减少免疫抑制相比，基于最佳可用数据，西多福韦治疗和减少 BKVAN 的免疫抑制似乎具有成本效益，并改善健康结果。然而，由于临床数据较弱，特别是在比较效果方面，增量成本效益仍存在中度不确定性。在更昔洛韦能够强烈推荐为常规治疗之前，仍需要进行充分的、有力的试验，以更好地确定 BKVAN 的最佳治疗策略。
