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.
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