The economic impact of cytomegalovirus infection after liver transplantation

Background. We studied the economic impact of cytomegalovirus (CMV) disease and its effective reduction with antiviral prophylaxis in liver transplant recipients. Method Analysis of institutional charge data accumulated during a prospecti ve, randomized, controlled trial comparing oral acyclovir 800 mg four times daily for 120 days (ACV) and intravenous ganciclovir 5 mg/kg every 12 h fo r 14 days followed by ACV for 106 days (GCV) was performed. Results. Liver transplant recipients who developed CMV disease had signific antly higher charges (median: $148,300) than those who developed asymptomat ic CMV infection ($119,600) or experienced no CMV infection ($114,100) (P<0 .01.). A multiple linear regression analysis indicated that CMV disease is associated with a 49% increase in charges, independent of other factors inf luencing increased hospitalization charges. In CMV-seronegative patients wh o received a CMV-seropositive donor organ, GCV prophylaxis was associated w ith a significant reduction in charges, as compared to ACV prophylaxis ($11 3,900 vs. $153,300, respectively; P=0.02). Conclusions. CMV disease is an independent risk factor for increased resour ce utilization associated with liver transplantation. The use of an effecti ve prophylactic antiviral regimen provides savings in health care resources , particularly in patients at high risk for developing CMV disease.