THE COST IMPACT OF CYTOMEGALOVIRUS DISEASE IN RENAL-TRANSPLANT RECIPIENTS

A retrospective case controlled study was performed to determine the c ost impact of cytomegalovirus disease in the first year following rena l transplantation as a basis for the analysis of cost effectiveness of prophylactic and therapeutic regimens directed at CMV infection. Elev en sequential cases of organ-specific CMV disease were matched with 22 controls for age, diabetic status, and donor/recipient CMV serologic status from 1 19 consecutive first cadaveric renal transplant recipien ts performed at a single university-affiliated, solid organ transplant unit between January 1, 1988 and March 31, 1990. The groups were comp arable for sex, HLA match and mismatch, incidence of initial graft dys function, and immunosuppression. Hospitalization data, resource utiliz ation, and costs for all 33 subjects were obtained for a one-year peri od after transplantation. The mean initial hospitalization time was co mparable for both CMV cases and controls (14.5 vs. 15.0 days, P=NS), b ut patients developing CMV disease averaged 59 hospital days during th e first year posttransplant versus 22 days in the control group (P=0.0 01). A mean of 31 days hospitalization was directly related to CMV dis ease. Mean total institutional costs, calculated in 1988 Canadian doll ars, were 2.5 times higher for patients with CMV disease than for cont rols ($42,611 vs. $17,309, P=0.001), reflecting predominantly a differ ence in general ward ($19,988 vs. $7484, P=0.001), hotel ($2508 vs. $9 27, P=0.001), clinical laboratory ($5420 vs. $2558, P=0.0001), radiolo gy ($1581 vs. $640, P=0.05), and pharmacy ($4916 vs. $1782, P=0.01) co sts and utilization. Operating room, special ward, ancillary, and mean per diem costs ($719 vs. $790, P=NS) were not significantly different between the two groups. Functional graft survival at 1 year was 72% i n patients with CMV disease compared with 86% in controls, reducing th e mean calculated cost-effectiveness of transplantation by 2.9-fold.Th ese data show that CMV disease has significant economic impact on rena l transplantation as a result of extended hospitalization. In order to develop a cost effective management approach to CMV infection, this i mpact must be considered when assessing therapeutic and prophylactic r egimens and protocols of organ allocation.