Cost-effectiveness of Two Preventive Strategies for Cytomegalovirus Infection in Intermediate Risk Colombian Renal Transplant Patients

OBJECTIVES: Our objective was to compare the cost-effectiveness of the two most
used valganciclovir-based cytomegalovirus (CMV) prophylaxis strategies, in intermediate risk renal transplant patients in Colombia. The two alternatives are
“universal prophylaxis” strategy, which uses valganciclovir for the first 90 days
post-transplantation, and “anticipated therapy”, which requires weekly viral load
surveillance, warranting therapy only when positive. METHODS: We designed a
TreeAge-based third party payer perspective (Colombian healthcare system)
decision tree, considering only direct medical costs, in 2014 Colombian pesos (1
USD ¼ 2000 COP) and a time horizon of one year. 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 official tariff manual (ISS 2001) with a
33% adjustment based on the health component of the Colombian Consumer
Price Index for the year 2014. Medication costs were obtained from the official
Ministry of Health information system (SISMED). 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 US$
15,481, whereas in the case of universal therapy the cost would be slightly lower
US$ 14,984 (incremental cost of US$ 497). Results did not change significantly with deterministic and probabilistic sensitivity analyses. CONCLUSIONS: For Colombian renal transplant patients with an intermediate risk of CMV infections,
universal prophylaxis strategy should be the best option.