Villeneuve Claire, Rerolle Jean-Phillipe, Couzi Lionel, Westeel Pierre-Francois, Etienne Isabelle, Esposito Laure, Kamar Nassim, Büchler Mathias, Thierry Antoine, Marquet Pierre, Monchaud Caroline
Department of Pharmacology, Toxicology and Centre of Pharmacovigilance, Centre Hospitalier Universitaire (CHU) Limoges, Limoges, France.
INSERM U1248 Pharmacology and Transplantation, Limoges, France.
Transplant Direct. 2024 Jul 26;10(8):e1678. doi: 10.1097/TXD.0000000000001678. eCollection 2024 Aug.
In kidney transplant recipients with positive serology (R+) for the cytomegalovirus (CMV), 2 strategies are used to prevent infection, whose respective advantages over the other are still debated. This study aimed to evaluate the cost-effectiveness and cost utility of antiviral prophylaxis against CMV versus preemptive therapy, considering CMV infection-free survival over the first year posttransplantation as the main clinical outcome.
Clinical, laboratory, and economic data were collected from 186 kidney transplant patients CMV (R+) included in the cohort study (85 patients who benefited from CMV prophylaxis and 101 from preemptive therapy). Costs were calculated from the hospital perspective and quality-adjusted life years (QALYs) using the EQ5D form. Using nonparametric bootstrapping, the incremental cost-effectiveness ratio (ICER) and cost utility were estimated (euros) for each case of infection avoided and each QALY gained for 1 y, respectively.
Prophylaxis significantly decreased the risk of CMV infection over the first year posttransplantation (hazard ratio 0.22, 95% confidence interval = 0.12-0.37, < 0.01). Compared with preemptive therapy, prophylaxis saved financial resources (€1155 per patient) and was more effective (0.42 infection avoided per patient), resulting in an ICER = €2769 per infection avoided. Prophylaxis resulted in a net gain of 0.046 in QALYs per patient and dominated over preemptive therapy with €1422 cost-saving for 1 QALY gained.
This study shows that CMV prophylaxis, although considered as a more expensive strategy, is more cost-effective than preemptive therapy for the prevention of CMV infections in renal transplant patients. Prophylaxis had a positive effect on quality of life at reasonable costs and resulted in net savings for the hospital.
在巨细胞病毒（CMV）血清学检测呈阳性的肾移植受者（R+）中，有两种策略用于预防感染，它们各自相对于对方的优势仍存在争议。本研究旨在评估针对CMV的抗病毒预防与抢先治疗的成本效益和成本效用，将移植后第一年无CMV感染生存作为主要临床结局。
从队列研究中纳入的186例CMV（R+）肾移植患者收集临床、实验室和经济数据（85例接受CMV预防，101例接受抢先治疗）。从医院角度计算成本，并使用EQ5D表格计算质量调整生命年（QALYs）。采用非参数自举法，分别估计每避免一例感染和每获得1年QALY的增量成本效益比（ICER）和成本效用（欧元）。
预防措施在移植后第一年显著降低了CMV感染风险（风险比0.22，95%置信区间=0.12 - 0.37，P<0.01）。与抢先治疗相比，预防措施节省了财政资源（每位患者1155欧元）且更有效（每位患者避免0.42例感染），导致每避免一例感染的ICER = 2769欧元。预防措施使每位患者的QALYs净增0.046，且优于抢先治疗，每获得1个QALY节省成本1422欧元。
本研究表明，CMV预防措施虽然被认为是一种更昂贵的策略，但在预防肾移植患者的CMV感染方面比抢先治疗更具成本效益。预防措施以合理成本对生活质量产生了积极影响，并为医院带来了净节省。
