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Cost-Effectiveness of Cidofovir Treatment of Polyomavirus Nephropathy in Kidney Transplant Recipients

Hua, Danny K.1; Howard, Kirsten2; Craig, Jonathan C.1,2; Chapman, Jeremy R.3; Wong, Germaine1,2,3,4

doi: 10.1097/TP.0b013e31823e7b0e
Clinical and Translational Research

Background. BK virus nephropathy (BKVAN) causes about 10% of late kidney graft loss. Cidofovir is widely used to treat BKVAN, but the magnitude of the health benefits and costs are largely unknown. We aimed to evaluate the incremental health benefits and costs of cidofovir and immunosuppression reduction compared with immunosuppression reduction alone in kidney transplant patients with BKVAN.

Methods. A probabilistic decision analytic model was developed to simulate a cohort of kidney transplant recipients aged 45 years and above with BKVAN who received cidofovir treatment compared with those who received standard care. The duration of the cycle was 1 year, and the model terminated when all recipients were deceased.

Results. Compared with immunosuppression reduction alone, in the base-case, the incremental health benefits of cidofovir were 0.0061 life-years saved (2.2 days), with savings of $20,756 over the lifetime of a transplant recipient. When varying the most influential variables (the probability of response to treatment and graft loss) between best and worst case scenarios, the incremental health outcomes ranged from −0.967 to 1.093 life-years saved, with incremental costs ranging from an extra $27,313 to saving $20,756.

Conclusions. Compared with immunosuppression reduction alone, based on best available data, cidofovir treatment and immunosuppression reduction for BKVAN seem to be cost saving and improves health outcomes. However, because of weak clinical data, particularly around comparative effectiveness, there is still moderate uncertainty in the incremental cost effectiveness. Adequately powered trials are still needed to better define optimal treatment strategies for BKVAN before cidofovir can be recommended strongly as routine therapy.

SUPPLEMENTAL DIGITAL CONTENT IS AVAILABLE IN THE TEXT.

1Centre for Kidney Research, Children's Hospital at Westmead, Australia.

2School of Public Health, University of Sydney, Sydney, New South Wales, Australia.

3Centre for Transplant and Renal Research, Westmead Hospital, Westmead, Australia.

The authors declare no funding or conflicts of interest.

Address correspondence to: Germaine Wong, M.B.B.S., M.Med. (ClinEpi), Ph.D., F.R.A.C.P., The Children's Hospital at Westmead, Locked Bag 4001, Sydney, New South Wales 2006, Australia. E-mail: germainew.wong@health.nsw.gov.au

D.K.H. designed and performed the research, analyzed data, and wrote the manuscript; K.H. participated in research design, advised on performance of the research and data analysis, and contributed to writing of the manuscript; J.C.C. and J.R.C. participated in data analysis and writing of the manuscript; and G.W. participated in research design, performance of the research, data analysis, and writing of the manuscript.

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.transplantjournal.com).

Received 30 August 2011. Revision requested 26 September 2011.

Accepted 21 October 2011.

© 2012 Lippincott Williams & Wilkins, Inc.