TY - JOUR
T1 - Resource utilization of cytomegalovirus immune globulin in prevention and treatment of cytomegalovirus infection in pediatric heart transplantation
AU - Asante-Korang, Alfred
AU - Carapellucci, Jennifer
AU - Krasnopero, Diane
AU - Brown, Brian
AU - Kiskaddon, Amy
AU - Wisotzkey, Bethany
AU - Blyumin, Gabriella
AU - Berman, David M.
AU - Namtu, Katie
N1 - Publisher Copyright:
© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
PY - 2019/12/1
Y1 - 2019/12/1
N2 - Background: There is debate whether cytomegalovirus immunoglobulin (CMV-Ig) is also needed for CMV prevention in heart transplant recipients in the era of good anti-viral drugs. Methods: We conducted a cost-savings quality initiative on CMV-Ig eventually leading to discontinuation of routine use of CMV-Ig for CMV prevention. Subsequently, a retrospective cohort study was conducted, comparing patients in cohort I (CMV-Ig plus anti-viral drugs, 2013-2015) to cohort II (anti-virals alone, 2015-2017). The medication acquisition costs and outcomes of CMV infection were assessed. Results: There were 39 total patients: 22/39(56%) in cohort I, with mean follow-up of 35.14 ± 17.38 months and 17/39(44%) in cohort II, mean follow-up of 19.12 ± 7.08 months. In cohort I, 5/22(22.7%) patients died from causes unrelated to CMV and 0/17 in cohort II died. There were 5/22(22.7%) patients in cohort I, and 2/17(9%) patients in cohort II that developed CMV infection (P =.508). Freedom from rejection was 81.8% (18/22) in cohort I, and 71% (12/17) in cohort II (P =.46), and 100% for allograft vasculopathy. There was significant reduction in medication acquisition cost following the protocol change of $260 839 or $15 343 per patient. Conclusion: Our study demonstrated an acquisition cost savings with similar clinical outcomes utilizing anti-viral CMV prophylaxis alone vs anti-viral prophylaxis plus CMV-Ig.
AB - Background: There is debate whether cytomegalovirus immunoglobulin (CMV-Ig) is also needed for CMV prevention in heart transplant recipients in the era of good anti-viral drugs. Methods: We conducted a cost-savings quality initiative on CMV-Ig eventually leading to discontinuation of routine use of CMV-Ig for CMV prevention. Subsequently, a retrospective cohort study was conducted, comparing patients in cohort I (CMV-Ig plus anti-viral drugs, 2013-2015) to cohort II (anti-virals alone, 2015-2017). The medication acquisition costs and outcomes of CMV infection were assessed. Results: There were 39 total patients: 22/39(56%) in cohort I, with mean follow-up of 35.14 ± 17.38 months and 17/39(44%) in cohort II, mean follow-up of 19.12 ± 7.08 months. In cohort I, 5/22(22.7%) patients died from causes unrelated to CMV and 0/17 in cohort II died. There were 5/22(22.7%) patients in cohort I, and 2/17(9%) patients in cohort II that developed CMV infection (P =.508). Freedom from rejection was 81.8% (18/22) in cohort I, and 71% (12/17) in cohort II (P =.46), and 100% for allograft vasculopathy. There was significant reduction in medication acquisition cost following the protocol change of $260 839 or $15 343 per patient. Conclusion: Our study demonstrated an acquisition cost savings with similar clinical outcomes utilizing anti-viral CMV prophylaxis alone vs anti-viral prophylaxis plus CMV-Ig.
KW - cytomegalovirus (CMV)
KW - cytomegalovirus immunoglobulin (CMV-Ig)
KW - ganciclovir
KW - heart disease: heart transplant
KW - infection and infectious agents
KW - pediatric
KW - valganciclovir
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U2 - 10.1111/ctr.13750
DO - 10.1111/ctr.13750
M3 - Article
C2 - 31692121
AN - SCOPUS:85075483923
SN - 0902-0063
VL - 33
JO - Clinical Transplantation
JF - Clinical Transplantation
IS - 12
M1 - e13750
ER -