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.
Highlights
Cytomegalovirus (CMV) infection and disease (CMV episodes) are global concerns after allogeneic hematopoietic stem cell transplantation (HSCT)
Preemptive treatment of CMV infection is currently the most common strategy to reduce the risk of CMV disease and the survey of Pollack et al showed that the CMV practices are not different between North America and Europe [4]
We aimed to evaluate the overcost related to CMV infection and disease over the first year of transplant, using a preemptive strategy, and to know whether the transplant cost can be predicted from the CMV serological status of the donor and recipient
Summary
Cytomegalovirus (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. Preemptive treatment of CMV infection is currently the most common strategy to reduce the risk of CMV disease and the survey of Pollack et al showed that the CMV practices are not different between North America and Europe [4]. This preference of many programs for preemptive over prophylactic treatment is mainly because of the side effects of the most common antiviral drugs (ganciclovir and foscavir) available to treat CMV. Longterm administration of foscavir raises safety issues, exposing patients to unacceptable renal toxicity [8]
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