Universal Prophylaxis is Cost Effective in Cytomegalovirus Serology-Positive Kidney Transplant Patients.
Summary of "Universal Prophylaxis is Cost Effective in Cytomegalovirus Serology-Positive Kidney Transplant Patients."
BACKGROUND.: The economic merit of universal prophylaxis and preemptive therapy in the management of cytomegalovirus (CMV) infection for serology positive (R+) kidney transplant patients remains undefined. We performed cost effectiveness and cost utility modeling comparing these two approaches. METHODS.: The incidence of CMV infection under universal prophylaxis and preemptive therapy was determined among 653 R+ patients from our institution and 416 R+ patients from various clinic trials, respectively. Standardized decision tree analysis and Markov transitional models were used to calculate cost and quality-adjusted life years (QALYs) from the prototypical clinical data and published literature. Incremental cost effectiveness and cost utility were calculated as dollars for one case of infection avoided and one QALY gained over 10 years, respectively. One- and two-way sensitivity analyses were performed. RESULTS.: The incidence of CMV infection was 4.1% and 55.5% within the first year after transplant for universal prophylaxis and preemptive therapy, respectively. Compared with preemptive therapy, universal prophylaxis incurred $1464 more in direct cost while saving $7309 in indirect cost, and resulted in a net gain of 0.209 in QALYs per patient over a 10-year period. Thus, universal prophylaxis dominates over preemptive therapy with a cost saving of $27,967 for 1 QALY gained. This cost saving was sensitive to the variation in the rate of CMV infection and disease with each approach. CONCLUSION.: Universal prophylaxis in CMV R+ kidney transplant patients is clinically effective and cost saving. It should be considered as the preferred approach.
Affiliation
Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
Journal Details
This article was published in the following journal.
Name: Transplantation
ISSN: 1534-6080
Pages: 237-44
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/21169881
- DOI: http://dx.doi.org/10.1097/TP.0b013e318200000c
Medical and Biotech [MESH] Definitions
Nitrofurantoin
A urinary anti-infective agent effective against most gram-positive and gram-negative organisms. Although sulfonamides and antibiotics are usually the agents of choice for urinary tract infections, nitrofurantoin is widely used for prophylaxis and long-term suppression.
Cytomegalovirus Retinitis
Infection of the retina by cytomegalovirus characterized by retinal necrosis, hemorrhage, vessel sheathing, and retinal edema. Cytomegalovirus retinitis is a major opportunistic infection in AIDS patients and can cause blindness.
Cost Of Illness
The personal cost of acute or chronic disease. The cost to the patient may be an economic, social, or psychological cost or personal loss to self, family, or immediate community. The cost of illness may be reflected in absenteeism, productivity, response to treatment, peace of mind, QUALITY OF LIFE, etc. It differs from HEALTH CARE COSTS, meaning the societal cost of providing services related to the delivery of health care, rather than personal impact on individuals.
Cost Allocation
The assignment, to each of several particular cost-centers, of an equitable proportion of the costs of activities that serve all of them. Cost-center usually refers to institutional departments or services.
Renal Plasma Flow, Effective
The amount of PLASMA flowing to the parts of the KIDNEY that function in the production of urine. It is the amount of plasma perfusing the KIDNEY TUBULES per unit time, generally measured by P-AMINOHIPPURATE clearance. It should be differentiated from RENAL PLASMA FLOW which is approximately 10% greater than the effective renal plasma flow.
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