Affiliation:
1. Takeda Pharmaceuticals U.S.A., Inc. Lexington Massachusetts USA
2. Infectious Diseases Division Massachusetts General Hospital Boston Massachusetts USA
3. Parexel Health Economics and Outcomes Research Modeling London UK
4. Takeda Development Center Americas, Inc. Lexington Massachusetts USA
5. Takeda Global Health Economics Zurich Switzerland
6. Parexel Health Economics and Outcomes Research Modeling Wavre Belgium
Abstract
AbstractThis study evaluated the cost‐effectiveness of maribavir versus investigator‐assigned therapy (IAT; valganciclovir/ganciclovir, foscarnet, or cidofovir) for post‐transplant refractory cytomegalovirus (CMV) infection with or without resistance. A two‐stage Markov model was designed using data from the SOLSTICE trial (NCT02931539), real‐world multinational observational studies, and published literature. Stage 1 (0–78 weeks) comprised clinically significant CMV (csCMV), non‐clinically significant CMV (n‐csCMV), and dead states; stage 2 (78 weeks–lifetime) comprised alive and dead states. Total costs (2022 USD) and quality‐adjusted life years (QALYs) were estimated for the maribavir and IAT cohorts. An incremental cost‐effectiveness ratio was calculated to determine cost‐effectiveness against a willingness‐to‐pay threshold of $100 000/QALY. Compared with IAT, maribavir had lower costs ($139 751 vs $147 949) and greater QALYs (6.04 vs 5.83), making it cost‐saving and more cost‐effective. Maribavir had higher acquisition costs compared with IAT ($80 531 vs $65 285), but lower costs associated with administration/monitoring ($16 493 vs $27 563), adverse events (AEs) ($11 055 vs $16 114), hospitalization ($27 157 vs $33 905), and graft loss ($4516 vs $5081), thus making treatment with maribavir cost‐saving. Maribavir‐treated patients spent more time without CMV compared with IAT‐treated patients (0.85 years vs 0.68 years), leading to lower retreatment costs for maribavir (cost savings: −$42 970.80). Compared with IAT, maribavir was more cost‐effective for transplant recipients with refractory CMV, owing to better clinical efficacy and avoidance of high costs associated with administration, monitoring, AEs, and hospitalizations. These results can inform healthcare decision‐makers on the most effective use of their resources for post‐transplant refractory CMV treatment.