Health Economics and Outcomes Research, Analysis Group, Inc, Boston, MA, USA.
Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA.
J Med Econ. 2022 Jan-Dec;25(1):367-380. doi: 10.1080/13696998.2022.2046388.
Management of cytomegalovirus (CMV) infection/disease in transplant recipients may be complicated by toxicities and resistance to conventional antivirals, adding to the overall healthcare burden. We characterized treatment patterns, healthcare resource utilization (HCRU), and costs to elucidate the healthcare burden associated with CMV therapies post-transplant.
A retrospective, longitudinal cohort study of transplant recipients using data from a US commercial insurance claims database (2013-2017) was conducted. Patients with a claim for post-transplant CMV diagnosis and anti-CMV treatment (ganciclovir, valganciclovir, foscarnet, or cidofovir) were identified (Treated CMV cohort) and compared with patients with neither a claim for CMV diagnosis nor anti-CMV treatment (No CMV cohort) for outcomes including HCRU and associated costs. Allogeneic hematopoietic cell transplantation (HCT) or solid organ transplantation (SOT) recipients were analyzed separately. Anti-CMV treatment patterns were assessed in the Treated CMV cohort. Costs were evaluated among subgroups with myelosuppression or nephrotoxicity.
Overall, 412 allogeneic HCT and 899 SOT patients were included in the Treated CMV cohorts, of which 41.7% and 52.5%, respectively, received multiple antiviral courses. Treated CMV cohorts compared with No CMV cohorts had higher mean monthly healthcare visits per patient (allogeneic HCT: 8.83 vs 6.61, SOT: 5.61 vs 4.45) and had an incremental adjusted mean monthly cost per patient differences of $8,157 (allogeneic HCT, < .004) and $2,182 (SOT, < .004). Among Treated CMV cohorts, HCRU and costs increased with additional CMV antiviral treatment courses. Mean monthly costs were higher for patients with than without myelosuppression or nephrotoxicity.
Results may not be generalizable to patients covered by government insurance or outside the USA.
CMV post-transplant managed with conventional treatment is associated with substantial HCRU and costs. The burden remains particularly high for patients requiring multiple treatment courses for post-transplant CMV or for transplant recipients who develop myelosuppression or nephrotoxicity.
移植受者巨细胞病毒（CMV）感染/疾病的治疗可能因毒性和对常规抗病毒药物的耐药性而变得复杂，从而增加整体医疗保健负担。我们描述了治疗模式、医疗资源利用（HCRU）和成本，以阐明移植后与 CMV 治疗相关的医疗保健负担。
对使用美国商业保险索赔数据库（2013-2017 年）的数据进行了一项回顾性、纵向队列研究。确定了有移植后 CMV 诊断和抗 CMV 治疗（更昔洛韦、缬更昔洛韦、膦甲酸钠或西多福韦）索赔的患者（治疗 CMV 队列），并将其与既无 CMV 诊断也无抗 CMV 治疗索赔的患者（无 CMV 队列）进行比较，以评估包括 HCRU 和相关成本在内的结果。分别分析异基因造血细胞移植（HCT）或实体器官移植（SOT）受者。在治疗 CMV 队列中评估了抗 CMV 治疗模式。在伴有骨髓抑制或肾毒性的亚组中评估了成本。
总体而言，在治疗 CMV 队列中纳入了 412 例异基因 HCT 和 899 例 SOT 患者，其中分别有 41.7%和 52.5%的患者接受了多次抗病毒治疗。与无 CMV 队列相比，治疗 CMV 队列中每位患者的平均每月医疗就诊次数更高（异基因 HCT：8.83 次 vs 6.61 次，SOT：5.61 次 vs 4.45 次），每位患者的调整后平均每月差异成本分别为 8157 美元（异基因 HCT，<0.004）和 2182 美元（SOT，<0.004）。在治疗 CMV 队列中，随着 CMV 抗病毒治疗疗程的增加，HCRU 和成本也随之增加。有骨髓抑制或肾毒性的患者的平均每月费用更高。
结果可能不适用于有政府保险或不在美国的患者。
用常规治疗方法治疗移植后 CMV 与大量 HCRU 和成本相关。对于需要多次治疗以治疗移植后 CMV 的患者或发生骨髓抑制或肾毒性的移植受者，其负担仍然特别高。
