The efficacy and cost–effectiveness of valacyclovir in cytomegalovirus prevention in solid organ transplantation

Abstract

Prevention of cytomegalovirus infection using antiviral prophylaxis or the pre-emptive therapy approach is an integral part of management of patients after solid organ transplantation. Regarding renal transplantation, valacyclovir is currently the only antiviral agent recommended for prophylaxis as an alternative to valganciclovir. This review article discusses studies documenting the efficacy and safety of valacyclovir prophylaxis as well as those comparing valacyclovir with other prophylactic regimens or with pre-emptive therapy. Also addressed are the economic aspects supporting the cost–effectiveness of valacyclovir prophylaxis and demonstrating lower costs compared with other cytomegalovirus preventive strategies.

Keywords::

• CMV
• pharmacoeconomics
• prophylaxis
• renal transplantation
• valacyclovir

Financial & competing interests disclosure

The study was supported by the European Regional Development Fund [ED2.1.00/03.0076] and the Charles University Research Fund [P36]. The authors have no affiliations or financial involvements with any organization or entity with financial interest or with financial conflict with the subject matter or materials discussed in the manuscript.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Prevention of cytomegalovirus (CMV) infection is an integral part of management of patients after solid organ transplantation.

• Regarding CMV prophylaxis after renal transplantation, high-dose valacyclovir is currently the recommended alternative to valganciclovir.

• Valacyclovir prophylaxis results in a significant decrease in the incidence of CMV disease and CMV viremia; the same applies to patients at risk of primary CMV infection. Moreover, prophylaxis has been associated with a reduced risk for acute allograft rejection.

• In head-to-head comparisons, the efficacy of valacyclovir did not differ from that of oral ganciclovir or valganciclovir prophylaxis. However, the studies included small numbers of patients at risk of primary CMV infection.

• The tolerability of valacyclovir prophylaxis is reasonably good. The main undesirable effects are neuropsychiatric side effects in the early post-transplant period. By contrast, leukopenia or neutropenia develops less often compared with valganciclovir regimens.

• In economic terms, valacyclovir prophylaxis is a less expensive strategy compared with valganciclovir prophylaxis or pre-emptive valganciclovir therapy, cutting the costs by an approximately US$2000–$3000 per one patient.