Resource utilization of cytomegalovirus immune globulin in prevention and treatment of cytomegalovirus infection in pediatric heart transplantation.

Abstract

BACKGROUND:

There is debate whether cytomegalovirus immunoglobulin (CMV-Ig) is also needed for CMV prevention in heart transplant recipients in the era of good anti-viral drugs.

METHODS:

We conducted a cost-savings quality initiative on CMV-Ig eventually leading to discontinuation of routine use of CMV-Ig for CMV prevention. Subsequently, a retrospective cohort study was conducted, comparing patients in cohort I (CMV-Ig plus anti-viral drugs, 2013-2015) to cohort II (anti-virals alone, 2015-2017). The medication acquisition costs and outcomes of CMV infection were assessed.

RESULTS:

There were 39 total patients: 22/39(56%) in cohort I, with mean follow-up of 35.14 ± 17.38 months and 17/39(44%) in cohort II, mean follow-up of 19.12 ± 7.08 months. In cohort I, 5/22(22.7%) patients died from causes unrelated to CMV and 0/17 in cohort II died. There were 5/22(22.7%) patients in cohort I, and 2/17(9%) patients in cohort II that developed CMV infection (P = .508). Freedom from rejection was 81.8% (18/22) in cohort I, and 71% (12/17) in cohort II (P = .46), and 100% for allograft vasculopathy. There was significant reduction in medication acquisition cost following the protocol change of $260 839 or $15 343 per patient.

CONCLUSION:

Our study demonstrated an acquisition cost savings with similar clinical outcomes utilizing anti-viral CMV prophylaxis alone vs anti-viral prophylaxis plus CMV-Ig.

• Authors: Alfred Asante-Korang, Jennifer Carapellucci, Diane Krasnopero, Brian Brown, Amy Kiskaddon, Bethany Wisotzkey, Gabriella Blyumin, David M Berman, Katie Namtu
• Journal: Clinical transplantation (Clin Transplant) Vol. 33 Issue 12 Pg. e13750 (12 2019) ISSN: 1399-0012 [Electronic] Denmark
• PMID: 31692121 (Publication Type: Journal Article)
• Copyright: © 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Chemical References

• Antiviral Agents
• Immunoglobulins

Topics

• Adolescent
• Antiviral Agents (therapeutic use)
• Child
• Child, Preschool
• Cytomegalovirus (drug effects, isolation & purification)
• Cytomegalovirus Infections (etiology, pathology, prevention & control)
• Female
• Follow-Up Studies
• Graft Rejection (etiology, pathology, prevention & control)
• Graft Survival (drug effects)
• Heart Transplantation (adverse effects)
• Humans
• Immunoglobulins (therapeutic use)
• Infant
• Male
• Postoperative Complications (etiology, pathology, prevention & control)
• Prognosis
• Retrospective Studies
• Risk Factors