Methods: We built a Markov state transition model using month-long cycles over a five-year (yr) time horizon, a 3% discount rate, and taking a healthcare system perspective. Model health states included episodes of CMV viremia and disease, ACR, and death. Identical hypothetical cohorts of D+/R- pts received 1 to 2 yrs of Px. Event probabilities were drawn from national data and local data from patients seen at our center. Cost data (Px and treatment, treatment of side effects, CMV-associated OI, viral load monitoring, etc.) were based on national estimates. Sensitivity analyses were performed on CMV infection incidence while on Px and time on Px.
Results: Receiving 1 and 2 yrs of Px had average total direct medical care costs of $115,182 and $141,290, respectively. The average life-years gained for receiving 2 yrs and 1 yr of Px were 3.11 and 2.81, respectively, resulting in an incremental cost-effectiveness ratio (ICER) of $87,984 per life-year gained. A sensitivity analysis varying CMV infection incidence on Px showed that 1 yr dominates 2 yrs of Px only when this incidence is >50% annually (i.e. 1 yr of Px costs less and gains more life years). Real-world experience, however, shows that breakthrough CMV rate while on VGC Px is much less than 50% due to Px efficacy. If duration of Px is extended to 3 yrs, the ICER increases to $95,815/life-year (3.34 life-years gained) when compared to 1 yr.
Conclusion: A longer duration of Px is predicted to lead to higher overall costs but increased life expectancy for CMV D+/R- mismatch Ltx pts. Px duration > 1 yr for these pts may be economically reasonable.
C. Bryce, None
M. Roberts, None
K. Smith, None
M. H. Nguyen, Merck: Grant Investigator , Research grant . Astellas: Grant Investigator , Research grant .
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