Cost-effectiveness of different strategies of cytomegalovirus prophylaxis in orthotopic liver transplant recipients

Cytomegalovirus (CMV) is an important cause of morbidity and mortality in l iver transplant recipients and several different strategies of CMV chemopro phylaxis are in practice. A cost-effective analysis was performed to compar e these strategies. A hypothetical cohort of liver transplant recipients wa s followed up for a year posttransplantation in a Markov model, as they mad e possible transitions to different states of health with respect to CMV in fection and disease. Different strategies of chemoprophylaxis were compared . Cost per patient, yield in terms of gain in quality-adjusted stages, amou nt of time spent in the state of CMV disease, and CMV-related mortality wer e the outcome measures compared. Oral ganciclovir administered universally to all transplant recipients was the most favored strategy. Restricting pro phylaxis to defined high-risk groups or extending the duration of prophylax is beyond 3 months did not improve cost-effectiveness. The strategy of shor tterm, oral ganciclovir-based chemoprophylaxis for CMV in liver transplant recipients is cost-effective by current standards of healthcare interventio ns.