Cost-utility analysis of letermovir as cytomegalovirus prophylaxis in adult recipients of allogeneic hematopoietic stem cell transplantation
Objective:To conduct a cost-effectiveness analysis of letermovir(sequential injection and tablet therapy)in combination with pre-emptive antiviral therapy(PET),as compared to PET alone,in preventing of cytomegalovirus(CMV)infection and disease in adult CMV-seropositive allogeneic hematopoietic stem cell transplan-tation(Allo-HSCT)recipients from the perspective of the healthcare system in China.Methods:A short-term decision tree model combined with a long-term Markov model was developed to simulate the clinical outcomes and costs of patients over a lifetime horizon.The clinical and efficacy parameters,incorporated in the model,were derived from the letermovir P001 trial(NCT02137772)and various published literature.Cost data were derived from public databases and through surveys of clinical experts.Both one-way and probabilistic sensitivity analysis were performed.Results:When compared to PET alone,the combination of letermovir prophylaxis with PET resulted in an increment of 0.44 in quality-adjusted life years(QALYs).The incremental cost-effectiveness ratio(ICER)of letermovir prophylaxis combined with PET was 59871 CNY·QALY-1,significantly lower than three times of the capita gross domestic product of China,thereby suggesting strong cost-effectiveness.The robustness of these base case analysis results was affirmed by the probabilistic sensitivity analyses.Conclusion:Letermovir,in comparison to PET alone,was deemed to be a cost-effective strategy for preventing CMV infection and disease in adult CMV-seropositive recipients of Allo-HSCT.
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