Cost Effectiveness of Intravenous Versus Oral Cytomegalovirus Treatment in Recipients of Allogeneic Hematopoietic Cell Transplant From Tunisian Hospital Perspective

OBJECTIVES: In the current context of budget constraint and limited resources, we assessed to compare the cost and efficacy of intravenous versus oral CMV treatment in recipients of allograft stem cell transplant (ASCT).

METHODS: We conducted a pharmaco-economic retrospective study, analyzing all consecutive CMV reactivations after ASCT, which were treated preemptively at the Bone Marrow Transplant Center in Tunisia from January 2018 to June 2022. Costs of oral and intravenous treatment were obtained from pharmacy purchase prices in 2024. Clinical outcomes (medicine, dosage, duration) derived from patient clinical report. Incremental cost-effectiveness ratios (ICERs) in terms of cost per quality-adjusted life year (QALY) gained was used. One-way and probabilistic sensitivity analyses were conducted to explore uncertainty.

RESULTS: Fifty-five patients developing 71 CMV reactivations were evaluated. 51 reactivations were treated by oral route and 20 reactivations with intravenous route. Remission was observed at 80% for intravenous treatment versus 68% for oral. The use of intravenous treatment would lead to an increase of QALYs (0.8) and direct medical cost ($6 355) compared with oral treatment (0.69 QALYs; $338) in CMV-seropositive recipients of an allo-HCT. Intravenous route use for CMV treatment was no cost-effective option versus oral route with ICER $54 700/QALY gained.

CONCLUSIONS: In the context of this study, we can consider that the cost to pay for a cured patient is high enough to be able to qualify the intraveneous approach as no cost-effective compared to the oral approach.