Cost-utility and budget impact analyses of valganciclovir for cytomegalovirus retinitis in patients with human immunodeficiency virus in Thailand.

BACKGROUND

Cytomegalovirus retinitis (CMVR) is an opportunistic infection frequently seen in people living with HIV (PLHIV) and can cause blindness. Intravenous (IV) ganciclovir is a typical CMVR treatment in Thailand, but oral valganciclovir is a more convenient alternative. However, its cost-effectiveness and budget impact remain unclear. Therefore, this study aimed to analyse the cost-utility and budget impact of oral valganciclovir compared with IV ganciclovir for CMVR treatment in PLHIV in Thailand.

METHODS

A hybrid decision tree/Markov model was developed to estimate costs, quality-adjusted life years (QALYs), and life years (LYs). Cost, utility, and probability parameters were obtained from the published literature and national databases. A cost-utility analysis was performed to estimate the incremental cost-effectiveness ratios, whereas a budget impact analysis (BIA) was performed to assess the financial implications. Sensitivity analyses were performed to assess model uncertainty.

RESULTS

Oral valganciclovir was the dominant treatment, providing higher QALYs (3.50 vs. 3.23) and LYs (4.78 vs. 4.75) and lower total costs (133,630 THB vs. 163,024 THB) than IV ganciclovir. One-way sensitivity analysis revealed that retinal detachment probability, drug cost, and inpatient service cost were the most influential parameters. Probabilistic sensitivity analysis revealed that 94.3% of the simulations placed oral valganciclovir in the dominant quadrant. BIA revealed an annual cost reduction of 6,408,714 THB when replacing IV ganciclovir with oral valganciclovir.

CONCLUSION

Oral valganciclovir was cost-effective and demonstrated budget reduction compared with IV ganciclovir. These findings provide valuable insights into enhancing CMVR management and ensuring efficient healthcare resource allocation.