OBJECTIVES: To evaluate the budget impact of letermovir versus no prophylaxis for the prevention of cytomegalovirus (CMV) infection and disease in adult CMV-seropositive (R+) allogeneic hematopoietic cell transplant (allo-HSCT) recipients from the United States (US) hospital perspective.

METHODS: Model was developed to estimate the annual budget impact adding letermovir prophylaxis to no prophylaxis to prevent clinically significant CMV infection (csCMVi) (CMV-related-hospitalizations, need for pre-emptive antiviral therapy (PET) and its associated adverse events) in a hypothetical cohort of 100 R+ adults undergoing allo-HSCT. Data on the prevalence of CMV seropositivity were obtained through literature. Clinical inputs were based on clinical trial data. Costs (2020 US$) included drug acquisition (AnalySource), PET-related adverse events and CMV-related rehospitalization based on the literature. Dosing was based on prescribing information and letermovir trial.

RESULTS: In the base-case scenario of a transplant center performing 100 allo-HSCT procedures in a year, approximately, 62 CMV seropositive adults were estimated to be eligible for use of letermovir. In the base-case scenario, annual number of csCMVi avoided by using letermovir were 15 out of 62 patients. Transitioning from no prophylaxis to letermovir prophylaxis resulted in $44,531, $76,868, and $131,682 reduction in the cost of PET use, PET-related adverse events, and CMV-related hospitalization. Overall, adding letermovir prophylaxis versus no prophylaxis resulted in $28 increase in the hospital budget mainly due to cost of medications. In the sensitivity analysis, where PET is utilized more frequently (>50%), letermovir would result in the cost-saving for the hospital inpatient setting.

CONCLUSIONS: Letermovir was associated with limited budget impact to the hospitals, primarily driven by drug acquisition costs but partially offset by lower cost of CMV antivirals used for PET and their associated AEs, and reduction in CMV-related rehospitalizations.