The Epidemiology, Treatment Patterns, and Costs of Cytomegalovirus Retinitis in the Post-HAART Era Among a National Managed-Care Population

Abstract

To examine the epidemiology, treatment patterns, and costs of cytomegalovirus (CMV) retinitis treatment in the post-HAART (highly active antiretroviral therapy) era, a retrospective cohort study was performed using data from US managed-care plans from 1997-2002. Cases with CMV retinitis were defined by requiring diagnosis codes for HIV (or AIDS), CMV, and retinitis and claims for anti-CMV treatment. Costs of oral, intravenous, and intraocular treatment periods were examined. The incidence of enrolled HIV or AIDS cases increased from 7 per million members in 1997 to 150 per million members in 2001. The incidence of CMV retinitis decreased from 23 per 10,000 HIV or AIDS cases in 1997 to 8 per 10,000 HIV or AIDS cases in 2001. The average duration of a CMV episode was 192 days and the average cost was 19,576 US dollars. In a multiple linear regression model adjusting for age, gender, insurance type, geographic region, HAART use, and co-existing AIDS-defining illnesses, intraocular and oral treatment periods saved 7135 and US dollars and 6866 US dollars, respectively, per treatment period compared with intravenous treatment (P < 0.05). The incidence of CMV retinitis decreased in this managed-care population during the post-HAART era. Use of oral or intraocular treatment saves costs compared with intravenous treatment in a managed-care environment.

Clinical features and outcomes of AIDS-related cytomegalovirus retinitis in the era of highly active antiretroviral therapy

“…New cases of CMV retinitis continue to be diagnosed due to reasons such as late diagnosis of HIV infection or AIDS, poor adherence to HAART treatment or viral resistance to one or more components of HAART therapy (4,21) . In developing countries, CMV retinitis is largely undiagnosed and the scale of the problem is still not known as there is no strategy for screening and management of the problem (21) .…”

“…In developing countries, CMV retinitis is largely undiagnosed and the scale of the problem is still not known as there is no strategy for screening and management of the problem (21) . Patients with CMV retinitis presented a similar immunological profile as observed in the era before HAART.…”

Cytomegalovirus Retinitis in the Post-cART Era

“…Valganciclovir may be administered as 900mg twice daily during induction therapy, and then continued at once daily dosing for maintenance [93]. A systematic review found that oral valganciclovir was preferable to intravenous ganciclovir on a cost-effectiveness basis [94]. Switching from intravenous to oral therapy resulted in a cost savings of $6866 USD per treatment period [94].…”

“…A systematic review found that oral valganciclovir was preferable to intravenous ganciclovir on a cost-effectiveness basis [94]. Switching from intravenous to oral therapy resulted in a cost savings of $6866 USD per treatment period [94]. Furthermore, compared to other available therapies, the once-daily oral dosing of valganciclovir is simple and convenient, increasing patient compliance with therapy [93].…”

Ocular association of HIV infection in the era of highly active antiretroviral therapy and the global perspective

“…However, systemic administration can cause severe side effects: severe neutropenia with ganciclovir and renal failure with foscarnet and cidofovir 52–54 . Other disadvantages include higher prevalence of drug resistance in contralateral eyes that subsequently develop retinitis, and higher cost of treatment compared to intraocular treatment 55,56 . Although one study did not find a difference in retinal detachment rate between systemic therapy and intravitreal ganciclovir implant, a recent review of 186 patients showed that the rate was 14‐fold higher with intravenous therapy compared to intravitreal therapy 49,57 .…”