Evaluation of treatment patterns, healthcare resource utilization, and costs among patients receiving treatment for cytomegalovirus following allogeneic hematopoietic cell or solid organ transplantation

Abstract

Aim

Management of cytomegalovirus (CMV) infection/disease in transplant recipients may be complicated by toxicities and resistance to conventional antivirals, adding to the overall healthcare burden. We characterized treatment patterns, healthcare resource utilization (HCRU), and costs to elucidate the healthcare burden associated with CMV therapies post-transplant.

Materials and methods

A retrospective, longitudinal cohort study of transplant recipients using data from a US commercial insurance claims database (2013–2017) was conducted. Patients with a claim for post-transplant CMV diagnosis and anti-CMV treatment (ganciclovir, valganciclovir, foscarnet, or cidofovir) were identified (Treated CMV cohort) and compared with patients with neither a claim for CMV diagnosis nor anti-CMV treatment (No CMV cohort) for outcomes including HCRU and associated costs. Allogeneic hematopoietic cell transplantation (HCT) or solid organ transplantation (SOT) recipients were analyzed separately. Anti-CMV treatment patterns were assessed in the Treated CMV cohort. Costs were evaluated among subgroups with myelosuppression or nephrotoxicity.

Results

Overall, 412 allogeneic HCT and 899 SOT patients were included in the Treated CMV cohorts, of which 41.7% and 52.5%, respectively, received multiple antiviral courses. Treated CMV cohorts compared with No CMV cohorts had higher mean monthly healthcare visits per patient (allogeneic HCT: 8.83 vs 6.61, SOT: 5.61 vs 4.45) and had an incremental adjusted mean monthly cost per patient differences of $8,157 (allogeneic HCT, p < .004) and $2,182 (SOT, p < .004). Among Treated CMV cohorts, HCRU and costs increased with additional CMV antiviral treatment courses. Mean monthly costs were higher for patients with than without myelosuppression or nephrotoxicity.

Limitations

Results may not be generalizable to patients covered by government insurance or outside the USA.

Conclusions

CMV post-transplant managed with conventional treatment is associated with substantial HCRU and costs. The burden remains particularly high for patients requiring multiple treatment courses for post-transplant CMV or for transplant recipients who develop myelosuppression or nephrotoxicity.

Keywords:

• Antivirals
• cytomegalovirus
• healthcare resource utilization
• hematopoietic cell transplantation
• solid organ transplantation
• treatment patterns

JEL classification codes:

• I12
• I1
• I
• I10

Transparency

Declaration of funding

This research was funded by Takeda Development Center Americas, Inc, Lexington, MA, USA.

Declaration of financial/other interests

WYC, PT-L, and MSD are employees and HCC was an employee (at the time the work was performed) of Analysis Group, Inc, which received funding from Takeda Development Center Americas, Inc to conduct this study. TB and IH are employees of and hold stock/stock options in Takeda Development Center Americas, Inc. RKA has received study funding as a clinical study site investigator for Aicuris, Astellas, Chimerix, Merck & Co., Oxford Immunotec, Qiagen, Regeneron Pharmaceuticals, and Takeda Development Center Americas, Inc, and has acted as an unpaid consultant for Takeda Development Center Americas, Inc.

A reviewer on this manuscript has disclosed that they have received honoraria from Astellas Pharma, Clinigen, Gilead, Janssen, Merck, Novartis, Pfizer. The Deputy Editor in Chief helped with adjudicating the final decision on this paper. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Author contributions

WYC, PT-L, HCC, RKA, MSD, IH, and TB contributed to the study design, and review and interpretation of the results. HCC performed statistical programming for the analysis of the results. All authors contributed to the drafting and critical revision of the manuscript, and approved the final text.

Acknowledgements

The authors would like to acknowledge the support of Suna Park and Nicolae Done of Analysis Group, Inc for their assistance with data analysis and statistical programming. Under the direction of the authors, Amy Holloway, DPhil, of Caudex, provided medical writing assistance for this manuscript. Editorial assistance was provided by Michael Rowlands, PhD, of Caudex, both funded by Takeda Development Center Americas, Inc.

Data availability statement

The data that support the findings of this study are available from IQVIA (PharMetrics Plus commercial health claims database). Restrictions apply to the availability of these data, which were used under license for this study. Data are available from WYC, PT-L, and MSD of Analysis Group with the permission of IQVIA.