Abstract
Oral valganciclovir is the alternative option for prophylaxis and treatment of cytomegalovirus (CMV) disease that is widely used in transplantation due to the equivalent safety and efficacy compared with intravenous ganciclovir. So valganciclovir was proposed for the inclusion into the national list of essential drug. The systematic review criteria were the original article of the full economic evaluation for valganciclovir or intravenous ganciclovir in various durations of therapy. Prophylaxis, pre-emptive prevention regimen and wait-and-treat regimen of only one or both of these drugs for all organ transplantation recipients were included to the study. The eligible studies showed 4 studies in the US, 2 studies compared between different duration of therapy of using prophylaxis valganciclovir, 1 study compared prophylaxis with pre-emptive therapy using valganciclovir, and the other compared pre-emptive valganciclovir with no prevention therapy. In European countries, there were 3 studies: compared prophylaxis ganciclovir among durations of therapy, compared prophylaxis with pre-emptive ganciclovir, and compared prophylaxis ganciclovir with prophylaxis valganciclovir. The studies targeted in kidney, lung, liver, pancreas, and hematopoietic stem cell transplantation in hospital, societal, or health system perspective. There were 5 of 7 studies modeled the Markov and decision tree and discounted 3-5% with 5 month to 10 year horizon to estimate costs and outcome, while 2 of 7 studies considered costs and outcome in 1 year after transplantation. The results showed prophylaxis 200 days was more cost-effective than pre-emptive and wait-and-treat regimen because of the superior outcome of longer duration prophylaxis in preventing early DNAemia, CMV disease, opportunistic infection, and graft rejection, but the costs were equally high of drug for prophylaxis, and laboratory monitoring for pre-emptive therapy. To compare the cost effectiveness between ganciclovir and valganciclovir, it could be concluded only the costs of using ganciclovir were high particularly in 1 year after transplantation due to catheter culture test, drug administration, room expenses, and intravenous caused adverse event. However, there was no the long-term costs and outcome presented. The studies from other countries were differently designed of comparator approach upon their routine practice and resource concerns. This systematic review could explore the elementary information for further economic analysis and making decision included valganciclovir into the Thai national list of essential drug.
