Letermovir prophylaxis reduced the incidence of clinically significant CMV infection from 56% to 34% (p < 0.001) compared to no prophylaxis in adult CMV-seropositive patients undergoing alloHCT.
Observational (n=362)
Yes
Does letermovir prophylaxis reduce overall direct treatment costs and healthcare resource utilization in adult patients undergoing alloHCT?
Letermovir prophylaxis after alloHCT significantly reduces the incidence of clinically significant CMV infection and hospital length of stay, but is associated with higher overall direct treatment costs compared to no prophylaxis.
Effect estimate: p < 0.001
Absolute Event Rate: 34% vs 56%
p-value: p=<0.001
Abstract Objectives Letermovir has demonstrated efficacy and tolerability as prophylaxis against clinically significant cytomegalovirus infection (csCMVi) in CMV-seropositive adult patients undergoing allogeneic hematopoietic cell transplantation (alloHCT) compared to alternative antivirals. Despite these advantages, associated costs remain substantial. This study addresses the evidence gap by evaluating the health economic impact of CMV prophylaxis with letermovir in a real-world setting for alloHCT patients. Methods This retrospective, multi-centre case-control study was conducted at six German tertiary care centres. A micro-costing approach evaluated hospitalisation and anti-CMV drug acquisition costs over a 48-week follow-up period post-alloHCT. The analysis included patients surviving at least 100 days following alloHCT, comparing individuals receiving letermovir prophylaxis (cases) with those who did not (controls) between January 2018 and April 2021. Results The incidence of csCMVi was significantly higher in the control than in the letermovir group (56%, n = 98 vs. 34%, n = 63, p < 0.001). Median hospital length of stay was significantly longer in the control group (45 days, IQR 36–66) compared to the letermovir group (39 days, IQR 32–55; p < 0.001). Hospitalisation costs were comparable ( p = 0.865), while anti-CMV drug acquisition and overall direct treatment costs were significantly higher in the letermovir group (€21,844, 95% CI 19,247 − 25,107 vs. €7,711, 95% CI 12,692 − 25,107, p < 0.001; 81,871, 95% CI 76,721 − 87,021 vs. 67,161, 95% CI 61,693 − 72,629, p < 0.001). Besides letermovir, cost drivers post-alloHCT were rehospitalisation and csCMVi. Conclusions Our study demonstrated higher anti-CMV drug acquisition costs and overall direct treatment costs in patients receiving letermovir prophylaxis compared to controls. However, these higher costs are accompanied by significantly improved clinical outcomes.
Engelhard等人（Mon，）对接受异基因造血细胞移植的成人CMV抗体阳性患者进行了观察研究，这些患者在移植后存活至少100天（n=362）。比较了使用letermovir预防与不使用letermovir预防（历史对照）在临床显著的巨噬细胞病毒感染（csCMVi）发生率上的影响（p < 0.001，p=<0.001）。与不使用预防相比，letermovir预防将成人CMV抗体阳性的alloHCT患者的临床显著CMV感染发生率从56%降低到34%（p < 0.001）。