Cost‐effectiveness analysis of cytomegalovirus prophylaxis in allogeneic hematopoietic cell transplant recipients from a US payer perspective

Abstract

To evaluate the cost‐effectiveness of letermovir versus no prophylaxis for the prevention of cytomegalovirus infection and disease in adult cytomegalovirus‐seropositive allogeneic hematopoietic cell transplantation (allo‐HCT) recipients. A decision model for 100 patients was developed to estimate the probabilities of cytomegalovirus infection, cytomegalovirus disease, various other complications, and death in patients receiving letermovir versus no prophylaxis. The probabilities of clinical outcomes were based on the pivotal phase 3 trial of letermovir use for cytomegalovirus prophylaxis versus placebo in adult cytomegalovirus‐seropositive recipients of an allo‐HCT. Costs of prophylaxis with letermovir and of each clinical outcome were derived from published sources or the trial clinical study reports. Incremental cost‐effectiveness ratios (ICERs) in terms of cost per quality‐adjusted life year (QALY) gained were used in the model. One‐way and probabilistic sensitivity analyses were conducted to explore uncertainty around the base‐case analysis. In this model, the use of letermovir prophylaxis would lead to an increase of QALYs (619) and direct medical cost ($1 733 794) compared with no prophylaxis (578 QALYs; $710 300) in cytomegalovirus‐seropositive recipients of an allo‐HCT. Letermovir use for cytomegalovirus prophylaxis was a cost‐effective option versus no prophylaxis with base‐case analysis ICER $25 046/QALY gained. One‐way sensitivity analysis showed the most influential parameter was mortality rate. The probabilistic sensitivity analysis showed a 92% probability of letermovir producing an ICER below the commonly accepted willingness‐to‐pay threshold of $100 000/QALY gained. Based on this model, letermovir use for cytomegalovirus prophylaxis was a cost‐effective option in adult cytomegalovirus‐seropositive recipients of an allo‐HCT.

New trends in the management of cytomegalovirus infection after allogeneic hematopoietic cell transplantation: a survey of the Infectious Diseases Working Pary of EBMT

“…On the other hand, several factors may have slowed down this policy such as the variable time interval between EMA approval and the authorization of letermovir prescription at different European countries, the costs of the drug prophylaxis and the need for every allogeneic-HCT unit to reformulate the annual budget and approve the costs for letermovir, and the attitude of the centres and haematologists to transfer quickly in the routine practice the indications coming from a clinical trial. Retrospective data from "real world" use and cost-effectiveness model analysis, confirmed that anti-CMV primary prophylaxis with letermovir is associated with a reduction of CMV infections, shorter hospitalizations, reduced costs and improvement of haematological and renal parameters [21][22][23]. In this regard, our interpretation of existing data support that a broader use of letermovir primary prophylaxis in the next future may result into an improvement of the overall transplant outcomes, as suggested by a post-hoc analysis on overall mortality conducted on the patients recruited in the phase III trial of letermovir versus placebo [24].…”

Impact of Letermovir Use for Cytomegalovirus Prophylaxis on Re-Hospitalization Following Allogeneic Hematopoietic Stem Cell Transplantation: An Analysis of a Phase III Randomized Clinical Trial

“…By reducing the risk of CS-CMVi (thereby decreasing the use of pre-emptive therapy) and re-hospitalization, letermovir may help to reduce the healthcare resource use associated with allogeneic HSCT. A recent health economic model based on this phase III trial and local cost data showed that CMV prophylaxis with letermovir was considered a cost-effective option in adult CMV-seropositive recipients of an allogeneic HSCT from a US payer perspective [12]. These findings may be of particular relevance to US healthcare providers considering the timeframe associated with the bundled payment system used by most US commercial payers [13].…”

New trends in the management of cytomegalovirus infection after allogeneic hematopoietic cell transplantation: a survey of the Infectious Diseases Working Party of EBMT

“…On the other hand, several factors may have slowed down this policy such as the variable time interval for the authorization of letermovir prescription at different European countries, the costs of the drug prophylaxis and the need for every allogeneic-HCT unit to reformulate the annual budget and approve the costs for letermovir, and the attitude of the centres and hematologists to utilise in the routine practice the indications coming from a clinical trial. Retrospective data from "real world" use and cost-effectiveness model analysis, con rmed that anti-CMV primary prophylaxis with letermovir is associated with a reduction of CMV infections, shorter hospitalizations, reduced costs and improvement of hematological and renal parameters [21][22][23] . In this regard, our interpretation of existing data support that a broader use of letermovir primary prophylaxis in the next future may result into an improvement of the overall transplant outcomes, as suggested by a post-hoc analysis on overall mortality conducted on the patient recruited in the phase III trial of letermovir versus placebo 24 .…”