1653. Cost Analysis of Ganciclovir (GCV) and Foscarnet (FOS) in Recipients of Allogenic Hematopoietic Cell Transplant (aHCT) with Cytomegalovirus (CMV) Viremia
Session: Poster Abstract Session: Viral Treatment and Prevention
Friday, October 6, 2017
Room: Poster Hall CD
  • Jason Chen_Ganciclovir vs. Foscarnet Cost Analysis in CMV Viremia_2017.pdf (451.2 kB)
  • Background:

    GCV and FOS are two treatment options for cytomegalovirus (CMV) viremia in recipients of aHCT. Current data does not show that one agent is more effective than the other, but both can lead to severe adverse reactions (myelosuppression with GCV, renal impairment and electrolyte imbalances with FOS). To our knowledge, there are no studies comparing the health care costs between GCV and FOS for the treatment of CMV viremia. The primary objective of this study is to compare health care resource use (HCRU) between GCV and FOS in the treatment of CMV viremia.


    Retrospective chart review. Inclusion criteria: patients who received GCV or FOS for at least 7 days between April 27, 2014 to December 31, 2015 for CMV viremia that occurred during the first year following aHCT, detectable CMV PCR for haploidentical and cord blood transplants, CMV PCR ≥ 1500 copies/mL for all other aHCT, and a rising CMV PCR in high risk patients (e.g. graft-vs-host disease, high dose corticosteroids, lymphopenia). Exclusion criteria: CMV disease before or with first viremia and concomitant cidofovir use. HCRU included drug, hospitalization and home health, dialysis, and growth factor costs. Drug costs were calculated using the wholesale acquisition costs (WAC), and other health care costs were calculated using reference costs from various databases.


    While not statistically significant, patients receiving GCV (n=52) required fewer days of IV therapy compared to those who received FOS (n=13): 21.5 days (3 to 83 days) vs. 27 days (6 to 88 days), p=0.47. Total duration of therapy was longer in the GCV group: 37 days (13 to 164 days) vs. 28 days (6 to 88 days), p=0.12. Hospitalization days for treatment were similar: 9 days (0 to 28 days) vs. 9 days (0 to 31 days), p=0.59. More GCV patients experienced at least a 50% reduction in white blood cell count: 33 patients (64%) vs. 6 patients (46%), p=0.34. However, growth factor utilization was higher in the FOS group: 28 patients (54%) vs. 9 patients (69%), p=0.36. Dialysis use was higher in the FOS group: 1 patient (2%) vs. 3 patients (23%), p<0.05. The total treatment cost was lower in the GCV group: $43,250 vs. $55,700.


    Health care resource costs trend towards favoring use of GCV over FOS for the treatment of CMV viremia.

    Jason Chen, Pharm.D.1, Jane Kriengkauykiat, PharmD2, James Ito, MD2, Bernard Tegtmeier, PhD3, Jana Dickter, MD4 and Sanjeet Dadwal, MD3, (1)Pharmacy, City of Hope National Medical Center, Duarte, CA, (2)Division of Infectious Diseases, City of Hope, Duarte, CA, (3)City of Hope, Duarte, CA, (4)Infectious Diseases, City of Hope, Duarte, CA


    J. Chen, None

    J. Kriengkauykiat, None

    J. Ito, Astellas Pharma: Speaker's Bureau , Speaker honorarium

    B. Tegtmeier, None

    J. Dickter, None

    S. Dadwal, Merck: Investigator , Research support
    GlaxoSmithKline: Investigator , Research support
    Ansun Biopharma: Investigator , Research support
    Oxford Immunotec: Investigator , Research support
    Gilead Sciences: Investigator , Research support

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.