Cost-effectiveness of two prevention cytomegalovirus infection schemes in renal transplant patients at intermediate risk in Colombia
Abstract
Introduction: Cytomegalovirus (CMV) is the most frequent opportunistic infection after renal transplantation. There are two strategies for its prevention: Universal prophylaxis, with valganciclovir for 90 days, and anticipated therapy, using weekly viral load surveillance, and therapy only if positive. Meta-analysis directly comparing both strategies have shown them to have similar effectiveness.
Objective: To determine which strategy is more cost-effective in intermediate risk patients in Colombia.
Materials and methods: We designed a third-party payer perspective decision tree, considering only direct medical costs in 2014 Colombian pesos (COP) (USD$ 1=COP$ 2,000) and a time horizon of one year. The target population was intermediate CMV risk patients (positive receptor). Transition probabilities were extracted from clinical studies, validated with a Delphi expert panel method; procedural costs were obtained from the ISS 2001 manual with a 33% increment based on the Consumer Price Index for 2014, while medication costs were obtained from the official Ministry of Health information system.
Results: Universal prophylaxis with valganciclovir was dominant, with lower costs and less probability of infection. The average cost of the first year in anticipated therapy would be COP$ 30,961,290, whereas in the case of universal therapy the cost would be COP$ 29,967,834 (incremental cost of COP$ 993,456).
Conclusions: For Colombian renal transplant patients at intermediate risk for CMV infection, universal prophylaxis strategy is the best option.
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References
Rosselli D, Rueda J, Díaz CE. Cost-effectiveness of kidney transplantation compared with chronic dialysis in end-stage renal disease. Saudi J Kidney Dis Transplant. 2015;26:733-
https://doi.org/10.4103/1319-2442.160175
Hernández D, Moreso F. Has patient survival following renal transplantation improved in the era of modern immunosuppression? Nefrologia. 2013;33:171-80. https://doi.org/10.3265/Nefrologia.pre2012.Nov.11743
Lumbreras C. Prevención de las complicaciones infecciosas en el receptor de un trasplante renal. Nefrol Sup Ext. 2011;2:92-7.
Squifflet J-P, Legendre C. The economic value of valacyclovir prophylaxis in transplantation. J Infect Dis. 002;186(Suppl.1):S116-22. https://doi.org/10.1086/342961
Gutiérrez E, Hernández E, Morales E, Praga M. Afectación gastrointestinal severa por CMV tardío: la importancia del tratamiento precoz. Nefrología. 2007;27:779-80.
De Keyzer K, van Laecke S, Peeters P, Vanholder R. Human cytomegalovirus and kidney transplantation: A clinician’s update. Am J Kidney Dis. 2011;58:118-26. https://doi.org/10.1053/j.ajkd.2011.04.010
Asberg A, Jardine AG, Bignamini AA, Rollag H, Pescovitz MD, Gahlemann CC, et al. Effects of the intensity of immunosuppressive therapy on outcome of treatment for CMV disease in organ transplant recipients. Am J Transplant. 2010;10:1881-8. https://doi.org/10.1111/j.1600-6143.2010.03114.x
Correa M, Ossa J, Builes M, Arbeláez M. Prevalencia de infección por citomegalovirus en receptores y donantes de trasplante renal en Medellín para 1988-1989. Acta Médica Colomb. 1990;15:175-9.
Díaz J, Henao J, Rodelo J, García A, Arbeláez M, Jaimes F. Incidence and risk factors for cytomegalovirus disease in a Colombian cohort of kidney transplant recipients. Transplant Proc. 2014;46:160-6. https://doi.org/10.1016/j.transproceed.2013.07.070
Arias-Murillo YR, Osorio-Arango K, Cortés JA. Seroprevalencia de citomegalovirus en donantes de órganos y receptores de trasplante renal, Colombia, 2010-2014. Biomédica. 2016;36:24-36. https://doi.org/10.7705/biomedica.v36i0.2938
Díaz-Betancur J, Henao JE, Jaimes FA. Efectos de la infección y la enfermedad por citomegalovirus en receptores de trasplante renal. Acta Médica Colomb. 2012;37:131-7.
Ramanan P, Razonable RR. Cytomegalovirus infections in solid organ transplantation: A review. Infect Chemother. 2013;45:260-71. https://doi.org/10.3947/ic.2013.45.3.260
Giakoustidis D, Antoniadis A, Fouzas I, Sklavos A, Giakoustidis A, Ouzounidis N, et al. Prevalence and clinical impact of cytomegalovirus infection and disease in renal transplantation: Ten years of experience in a single center. Transplant Proc. 2012;44:2715-7. https://doi.org/10.1016/j.transproceed.2012.09.098
Razonable RR. Management strategies for cytomegalovirus infection and disease in solid organ transplant recipients. Infect Dis Clin North Am. 2013;27:317-42. https://doi.org/10.1016/j.idc.2013.02.005
Witzke O, Hauser IA, Bartels M, Wolf G, Wolters H, Nitschke M. Valganciclovir prophylaxis versus preemptive therapy in cytomegalovirus-positive renal allograft recipients: 1-year results of a randomized clinical trial. Transplantation. 2012;93:61-8. https://doi.org/10.1097/TP.0b013e318238dab3
Cortés JA, Yomayusa N, Arias YR, Arroyave IH, Cataño JC, García P, et al. Consenso colombiano para la estratificación, diagnóstico, tratamiento y prevención de la infección por citomegalovirus en pacientes adultos con trasplante renal. Infectio. 2015;20:250-64. https://doi.org/10.1016/j.infect.2015.10.005
Kalil AC, Mindru C, Florescu DF. Effectiveness of valganciclovir 900 mg versus 450 mg for cytomegalovirus prophylaxis in transplantation: Direct and indirect treatment comparison meta-analysis. Clin Infect Dis. 2011;52:313-21. https://doi.org/10.1093/cid/ciq143
Kotton CN. CMV: Prevention, diagnosis and therapy. Am J Transplant. 2013;13:24-40. https://doi.org/10.1111/ajt.12006
Florescu DF, Qiu F, Schmidt CM, Kalil AC. A direct and indirect comparison meta-analysis on the efficacy of cytomegalovirus preventive strategies in solid organ transplant. Clin Infect Dis. 2014;58:785-803. https://doi.org/10.1093/cid/cit945
Kalil AC, Levitsky J, Lyden E, Stoner J, Freifeld AG. The efficacy of strategies to prevent organ disease by cytomegalovirus in solid organ transplant recipients. Ann Intern Med. 2005;143:870-80. https://doi.org/10.7326/0003-4819-143-12-200512200-00005
Hellemans R, Beutels P, Ieven M, Verpooten GA, Bosmans JL. Cost analysis in favor of a combined approach for cytomegalovirus after kidney transplantation: A single-center experience. Transpl Infect Dis. 2013;15:70-8. https://doi.org/10.1111/tid.12023
Kotton CN, Kumar D, Caliendo AM, Åsberg A, Chou S, Danziger-Isakov L, et al. International consensus guidelines on the management of cytomegalovirus in solid organ transplantation. Transplantation. 2013;89:779-95. https://doi.org/10.1097/TP.0b013e31829df29d
Luan FL, Kommareddi M, Ojo AO. Universal prophylaxis is cost effective in cytomegalovirus serology-positive kidney transplant patients. Transplantation. 2011;91:237-44. https://doi.org/10.1097/TP.0b013e318200000c
Couzi L, Helou S, Bachelet T, Martin S, Moreau K, Morel D, et al. Preemptive therapy versus valgancyclovir (sic) prophylaxis in cytomegalovirus-positive kidney transplant recipients receiving antithymocyte globulin induction. Transplant Proc. 2012;44:2809-13. https://doi.org/10.1016/j.transproceed.2012.09.029
Luna E, Caravaca F, Ferreira F, Fernández N, Martín P, Vargas ML, et al. Effect of cytomegalovirus infection on survival of older kidney transplant patients (D+/R+): Impact of valganciclovir prophylaxis versus preemptive therapy. Transplant Proc. 2016;48:2931-37. https://doi.org/10.1016/j.transproceed.2016.06.062
Instituto de Evaluación Tecnológica en Salud. Manual para la elaboración de evaluaciones económicas en salud. Bogotá: IETS; 2014. p.36. Fecha de consulta: 27 de abril de 2017. Disponible en: http://www.iets.org.co/Manuales/Manuales/Manual%20evaluacio%CC%81n%20econo%CC%81mica%20web%2030%20sep.pdf
López M. Incidencia, frecuencia, etiología y factores de riesgo para la infección en pacientes adultos con trasplante renal de un programa de trasplante de Bogotá (tesis). Bogotá: Universidad Nacional de Colombia; 2015. p. 48. Fecha de consulta: 27 de abril de 2017. Disponible en: http://www.bdigital.unal.edu.co/49209/1/52965694.2015.pdf.
Strippoli GF, Hodson EM, Jones C, Craig JC. Preemptive treatment for cytomegalovirus viremia to prevent cytomegalovirus disease in solid organ transplant recipients. Transplantation. 2006;81:139-45. https://doi.org/10.1097/01.tp.0000183970.71366.da
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