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September 14, 2026PharmacoEconomics - OpenOpen Access

Budget Impact of Prophylactic Letermovir to Prevent Cytomegalovirus Disease in High-Risk Adult Kidney Transplant Recipients

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Why the study?

Does introducing letermovir for CMV prophylaxis reduce budget impact compared to valganciclovir only in high-risk kidney transplant patients?

Population

Hypothetical health plan of 1,000,000 members, including 18 high-risk adult kidney transplant patients per…

Comparison

Letermovir as CMV prophylaxis with increasing… vs Market scenario with valganciclovir (VGCV) only

Design

Other

Follow-up

5 years (modeled)

Key result

Introducing letermovir for CMV prophylaxis in high-risk kidney transplant recipients generated estimated cost savings ranging from -$0.0020 to -$0.0027 per member per month over 5 years compared to a valganciclovir-only scenario.

Authors

MJM. JootunIKIrina KolobovaVTV Turzhitsky

Discussion

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Member takes

Overview

May support letermovir adoption for CMV prophylaxis in high-risk kidney transplant recipients due to cost savings; extends phase III data with US payer budget impact estimates.

Key Points

  • To evaluate the five-year budget impact of introducing letermovir for cytomegalovirus prophylaxis compared to a valganciclovir-only standard of care in high-risk adult kidney transplant recipients from a United States payer perspective.
  • Modeled a hypothetical US health plan of 1,000,000 members comprising 18 high-risk kidney transplant recipients per year over a 5-year time horizon.
  • Evaluated direct medical costs including drug acquisition, administration, leukopenia/neutropenia (LN) events, and downstream sequelae across scenarios with increasing letermovir uptake versus valganciclovir alone.
  • Annual total healthcare plan costs were US$1,628,307 without letermovir, compared to US$1,604,558 in year 1 and US$1,596,297 in year 5 with letermovir, generating incremental cost per member per month savings of -US$0.0020 to -US$0.0027.
  • Deterministic sensitivity analysis demonstrated that the incidence rate of leukopenia/neutropenia on valganciclovir and the management costs of these hematologic adverse events were the most influential drivers of cost savings.

Structured PICO

Does introducing letermovir for CMV prophylaxis reduce budget impact compared to valganciclovir only in high-risk kidney transplant patients?

P
Population
A hypothetical US health plan of 1,000,000 members, including 18 high-risk adult kidney transplant recipients (CMV D+/R-) per year eligible for CMV prophylaxis, modeled over 5 years.
I
Intervention
Letermovir as CMV prophylaxis with increasing market share over 5 years
C
Comparator
Market scenario with valganciclovir (VGCV) only
O
Outcome
Total budget impact and incremental cost per member per month (PMPM, 2025 USD)

Main Result

Effect estimate: -$0.0020 to -$0.0027 PMPM

Introducing letermovir for CMV prophylaxis in high-risk kidney transplant patients is estimated to provide cost savings from a US payer perspective, primarily by preventing leukopenia/neutropenia events.

Limitations

  • Assumes constant rates of prophylaxis utilization and LN incidence based on clinical trial data, which may not reflect real-world variations.
  • Short time horizon of the model does not reflect potential long-term downstream effects of LN.
  • Considers managing LN events and associated clinical events based on a fixed average cost, which can vary significantly.
  • Relies on accuracy and generalizability of input parameters from diverse sources.
  • Real-world studies informing clinical event rates were not limited to D+/R- patients.
  • Connections drawn from real-world data analysis between clinical events and LN represent observed patterns, not direct cause-and-effect relationships.

Cite This Study

Jootun et al. (2026) studied High-risk adult kidney transplant recipients (CMV D+/R-) (n=1,000,000). Letermovir vs. Valganciclovir was evaluated on Total annual budget impact and incremental cost per member per month (PMPM) (-$0.0020 to -$0.0027 PMPM). Introducing letermovir for CMV prophylaxis in high-risk kidney transplant recipients generated estimated cost savings ranging from -$0.0020 to -$0.0027 per member per month over 5 years compared to a valganciclovir-only scenario.

synapsesocial.com/papers/6aa7afef79e9260bc85aaccbhttps://doi.org/10.1007/s41669-026-00679-2
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