Cost-effectiveness of maribavir versus conventional antiviral therapies for post-transplant refractory cytomegalovirus infection with or without genotypic resistance: A US perspective

J Med Virol. 2024 Apr;96(4):e29609. doi: 10.1002/jmv.29609.

Abstract

This study evaluated the cost-effectiveness of maribavir versus investigator-assigned therapy (IAT; valganciclovir/ganciclovir, foscarnet, or cidofovir) for post-transplant refractory cytomegalovirus (CMV) infection with or without resistance. A two-stage Markov model was designed using data from the SOLSTICE trial (NCT02931539), real-world multinational observational studies, and published literature. Stage 1 (0-78 weeks) comprised clinically significant CMV (csCMV), non-clinically significant CMV (n-csCMV), and dead states; stage 2 (78 weeks-lifetime) comprised alive and dead states. Total costs (2022 USD) and quality-adjusted life years (QALYs) were estimated for the maribavir and IAT cohorts. An incremental cost-effectiveness ratio was calculated to determine cost-effectiveness against a willingness-to-pay threshold of $100 000/QALY. Compared with IAT, maribavir had lower costs ($139 751 vs $147 949) and greater QALYs (6.04 vs 5.83), making it cost-saving and more cost-effective. Maribavir had higher acquisition costs compared with IAT ($80 531 vs $65 285), but lower costs associated with administration/monitoring ($16 493 vs $27 563), adverse events (AEs) ($11 055 vs $16 114), hospitalization ($27 157 vs $33 905), and graft loss ($4516 vs $5081), thus making treatment with maribavir cost-saving. Maribavir-treated patients spent more time without CMV compared with IAT-treated patients (0.85 years vs 0.68 years), leading to lower retreatment costs for maribavir (cost savings: -$42 970.80). Compared with IAT, maribavir was more cost-effective for transplant recipients with refractory CMV, owing to better clinical efficacy and avoidance of high costs associated with administration, monitoring, AEs, and hospitalizations. These results can inform healthcare decision-makers on the most effective use of their resources for post-transplant refractory CMV treatment.

Keywords: cost‐effectiveness; cytomegalovirus; maribavir; quality‐adjusted life years.

Publication types

  • Research Support, Non-U.S. Gov't
  • Comparative Study

MeSH terms

  • Adult
  • Antiviral Agents* / economics
  • Antiviral Agents* / therapeutic use
  • Benzimidazoles* / economics
  • Benzimidazoles* / therapeutic use
  • Cost-Benefit Analysis*
  • Cytomegalovirus / drug effects
  • Cytomegalovirus / genetics
  • Cytomegalovirus Infections* / drug therapy
  • Cytomegalovirus Infections* / economics
  • Dichlororibofuranosylbenzimidazole / analogs & derivatives*
  • Drug Resistance, Viral
  • Female
  • Genotype
  • Humans
  • Male
  • Middle Aged
  • Quality-Adjusted Life Years*
  • Ribonucleosides* / economics
  • Ribonucleosides* / therapeutic use
  • Transplant Recipients
  • Vereinigte Staaten

Substances

  • maribavir
  • Antiviral Agents
  • Ribonucleosides
  • Benzimidazoles
  • Dichlororibofuranosylbenzimidazole