Economic burden of preemptive treatment of CMV infection after allogeneic stem cell transplantation: a retrospective study of 208 consecutive patients

Abstract

BackgroundCytomegalovirus (CMV) infection and disease (CMV episodes) are global concerns after allogeneic hematopoietic stem cell transplantation (HSCT). They affect survival, both by direct and indirect effects. Due to safety issues of current anti-CMV antivirals, long-term CMV prophylaxis is poorly tolerated and the most common strategy to decrease the incidence of CMV disease is preemptive. New, less toxic, molecules are currently being assessed for CMV prophylaxis which should replace or considerably decrease the preemptive approach. The aim of this study was to assess the economic burden of CMV episodes after HSCT with a preemptive approach.MethodsWe analyzed data from 208 consecutive adults transplanted in our institution, between 2008 and 2013. Hospital resource utilization was retrieved via the linked hospital admissions and Diagnostic Related Groups for the period of conditioning to 12 months after transplant.ResultsCMV episodes occurred in 70 patients (34%) over the first 12 months following HSCT, after a mean of 75 days (median: 46 (7–334)). The mean total length of stay was significantly associated with the occurrence of a CMV episode (113.9 vs. 87.5 days, p = 0.0002) but was associated neither with the pre-transplant CMV serology of donors/recipients nor with survival. The mean cost of transplant was €104,016 (SD = €37,281) after 12 months. Bivariate and multivariate analyses indicated that the occurrence of >1 CMV episode increased the costs of allogeneic HSCT by 25–30% (p < 0.0001).ConclusionOur study, which is the largest, single-institution cost study of allogeneic HSCT in Europe, shows that two or more CMV episodes significantly increased the transplant cost. New prophylactic strategies to prevent CMV infection and disease should decrease transplant costs.

The clinical and economic impact of cytomegalovirus infection in recipients of hematopoietic stem cell transplantation

“…Indeed, when the analysis was limited to allogeneic HSCT recipients, the cost increase due to CMV‐I was attenuated (approximately $86 per day, or a 14% relative increase), and was not statistically significant. Although modest compared to figures reported from some centers, it is similar in scope to that estimated by Robin et al (25%‐30%). While an estimated incremental cost of $24 892 per transplant complicated by CMV‐I is not trivial, these figures are likely an underestimate considering that we could not capture some outpatient procedure cost data.…”

“…Similarly, recent studies suggest that CMV‐I may have a protective effect against relapse, but perhaps only in select populations . Finally, as new strategies for CMV management and prevention become available, it will be important to have a firm understanding of the economic impact of CMV‐I in HSCT . In this study, we aimed to describe the clinical and economic impact of CMV‐I in an HSCT cohort in which preemptive CMV antiviral treatment was universally administered at first detectable CMV DNAemia.…”

Comparative Efficacy and Safety of Different Antiviral Agents for Cytomegalovirus Prophylaxis in Allogeneic Hematopoietic Cell Transplantation: A Systematic Review and Meta-Analysis

“…However, considering a minimal duration of the at-risk period for CMV reactivation of 3 months, these new prophylactic approaches will be probably more expensive than the actual preemptive approach, whose duration of treatment is usually limited to 2 to 4 weeks (ie, due to side effects such as nephrotoxicity) [37]. In contrast, the occurrence of 2 or more CMV episodes increased the cost of a transplant by 25% to 30% in a single-center study, which could be saved if any efficient CMV prophylaxis would dramatically decrease CMV episodes including an acceptable safety profile while improvement in overall survival would be even cost effective [37,38]. Future cost-effectiveness studies are needed to evaluate the economic outcome of current antiviral prophylaxis in clinical practice.…”

Cytomegalovirus Infection Incidence and Risk Factors Across Diverse Hematopoietic Cell Transplantation Platforms Using a Standardized Monitoring and Treatment Approach: A Comprehensive Evaluation from a Single Institution

“…In addition, CMV infection increases the risks of graft failure and graft-versus-host disease (GVHD), whereas treating CMV infection in the presence of poor graft function or in conjunction with immunosuppressive agents (especially steroids) for GVHD increases the risk from infections [4,6,7]. Finally, the treatment of CMV-associated complications post-HCT is associated with longer hospital length of stay, and CMV therapy carries a substantial financial burden [8,9].…”