Department of Medicine, Queen Mary Hospital, Hong Kong, China.
Global Medical & Scientific Affairs, MSD, Hong Kong, Hong Kong.
J Med Econ. 2020 Dec;23(12):1485-1492. doi: 10.1080/13696998.2020.1843321. Epub 2020 Nov 12.
The cost-effectiveness of letermovir as cytomegalovirus (CMV) prophylaxis in adult seropositive patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT), compared with the conventional strategy of preemptive treatment, has not been evaluated in Asia.
A decision analytical model, simulating the clinical progression of CMV infection on a lifetime horizon, was developed to compare prophylactic strategy with letermovir with preemptive therapy alone as anti-CMV strategies. Prophylaxis comprised administering letermovir for 14 weeks, with clinical outcomes measured at 24 weeks, followed by preemptive therapy if CMV infection occurred. This approach was modeled on outcomes of the letermovir phase 3 clinical study. The model enumerated the cost of letermovir prophylaxis, quality-adjusted life years (QALYs), and incremental cost per QALYs gained with prophylaxis. The opposite arm involved regular monitoring and preemptive therapy for CMV reactivation. Real-world costs from the adult HSCT center at Queen Mary Hospital, Hong Kong, were adopted for analysis. Costs and clinical benefits, expressed as QALYs, were discounted at 3% per year.
Letermovir prophylaxis compared with preemptive therapy only would lead to an increase of life-year and QALYs at increased costs. Incremental cost-effectiveness analysis showed that letermovir prophylaxis had an associated cost of HKD 193,580 for each life-year gained, and HKD 234,675 for each QALY gained. Probabilistic sensitivity analysis showed that the majority of incremental cost-effectiveness ratio fell below the cost-effectiveness threshold of HKD 382,046 (one gross domestic product per capita) per QALY gained.
Letermovir prophylaxis would be cost-effective for preventing CMV infection in adult seropositive allogeneic HSCT recipients in Hong Kong.
在亚洲，尚未评估更昔洛韦洛韦酯作为巨细胞病毒 (CMV) 预防药物用于接受异基因造血干细胞移植 (HSCT) 的成人血清阳性患者的成本效益，与抢先治疗的传统策略相比。
开发了一种决策分析模型，在终生范围内模拟 CMV 感染的临床进展，以比较预防性策略与更昔洛韦洛韦酯和单独抢先治疗作为抗 CMV 策略。预防包括使用更昔洛韦洛韦酯治疗 14 周，如果发生 CMV 感染，则进行抢先治疗。这种方法是基于更昔洛韦洛韦酯 3 期临床试验的结果。该模型列举了更昔洛韦洛韦酯预防的成本、质量调整生命年 (QALY) 和预防带来的增量成本每获得一个 QALY。相反的方法是定期监测和抢先治疗 CMV 再激活。采用香港玛丽医院成人 HSCT 中心的实际成本进行分析。成本和临床效益，以 QALY 表示，每年贴现 3%。
与单独抢先治疗相比，更昔洛韦洛韦酯预防会增加生命年和 QALY，但成本也会增加。增量成本效益分析表明，更昔洛韦洛韦酯预防每获得一个生命年的相关成本为 193580 港元，每获得一个 QALY 的相关成本为 234675 港元。概率敏感性分析表明，增量成本效益比的大多数都低于每获得一个 QALY 的成本效益阈值 382046 港元（一个人均国内生产总值）。
在香港，更昔洛韦洛韦酯预防对预防成人血清阳性异基因 HSCT 受者的 CMV 感染具有成本效益。
