Análisis coste-utilidad de valganciclovir durante 200 días frente a 100 días post-trasplante como tratamiento preventivo de la enfermedad por citomegalovirus en receptores de trasplante renal de alto riesgo

  • Lluis Guirado-Perich
  • Constantino Fernández-Rivera
  • Julián Torre-Cisneros
  • Eliazar Sabater-Cabrera
  • Elena Ruiz-Beato
  • Cristina Varela
Artículo de Investigación Original
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Resumen

Objetivo

Estimar la relación coste-utilidad de valganciclovir durante 200 días (VGC 200) frente a valganciclovir durante 100 días (VGC 100) en pacientes que han recibido un trasplante renal de alto riesgo (TRAR) D+/R−, desde la perspectiva del Sistema Nacional de Salud (SNS) en España.

Métodos

Se desarrolló un modelo de Markov para simular la historia natural de la progresión de la enfermedad por citomegalovirus en una cohorte de 10.000 pacientes durante 10 años. Los datos de la enfermedad se obtuvieron del ensayo IMPACT (año 1) y de la mejor evidencia científica disponible (años 2–10). Los costes unitarios (€ de 2010) se obtuvieron del Catálogo de Medicamentos y de la base de datos e-Salud. Los valores de utilidad se tomaron de la literatura. Se aplicó una tasa de descuento del 3 % para costes y resultados. Los resultados se expresaron como coste incremental de VGC 200 frente a VGC 100 por año de vida ajustado por calidad (AVAC) ganado. Se realizó un análisis de sensibilidad (AS) univariante y multivariante.

Resultados

VGC 200 proporciona mejores resultados que VGC 100 (5,002 AVAC frente a 4,764 AVAC; 0,238 AVAC ganados por paciente). El coste promedio por paciente fue de 109.012,11 € con VGC 200 y de 110.305,14 € con VGC 100 (ahorro de costes de 1.293,03 € por paciente). Los resultados del AS muestran la robustez del análisis.

Conclusiones

La administración de VGC 200 días frente a VGC 100 días en pacientes que han recibido un TRAR D+/R− es una estrategia eficiente desde la perspectiva del SNS en España.

Palabras clave

Trasplante renal Citomegalovirus Valganciclovir Coste-utilidad 

Abstract

Objective

To develop a cost-utility analysis to evaluate prolonged prophylaxis with 200 days on valganciclovir (VGC 200) versus 100 days on valgancidovir (VGC 100) in high-risk kidney transplant recipients HRKT D+/R−, from the perspective of the Spanish National Healthcare System (NHS).

Methods

A Markov model was designed to simulate the cytomegalovirus disease progression in a cohort of 10,000 patients over 10 years. Data on the disease evolution were obtained from the IMPACT trial for year 1 and the best available scientific evidence for years 2–10. Unit costs (€2010) were obtained from the Spanish Drug Catalogue and e-Salud database. Utility values were obtained from literature. The annual discount rate was 3 % for costs and outcomes. Results were shown as incremental cost of VGC 200 versus VGC 100 per quality-adjusted life year (QALY) gained. A one- and multi-way sensitivity analysis was performed.

Results

Treatment with VGC 200 provided better results than VGC 100 (5.002 versus 4.764 QALY; 0,238 QALY gained per patient). The average overall cost per patients was €109,012.11 with VGC 200 and €110,305.14 with VGC 100. Savings per patient treated with VGC 200 were €1,293.03. Sensitivity analysis confirms the robustness of the results.

Conclusion

Treatment with VGC 200 days compared to VGC 100 days in HRKT patients is an efficient strategy from the perspective of the Spanish NHS.

Keywords

Kidney transplantation Cytomegalovirus Valganciclovir Cost-utility 
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Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  • Lluis Guirado-Perich
    • 1
  • Constantino Fernández-Rivera
    • 2
  • Julián Torre-Cisneros
    • 3
  • Eliazar Sabater-Cabrera
    • 4
  • Elena Ruiz-Beato
    • 5
  • Cristina Varela
    • 5
  1. 1.Unidad de Trasplante RenalFundación PuigvertBarcelonaEspaña
  2. 2.Servicio de NefrologíaComplexo Hospitalario UniversitarioA CoruñaEspaña
  3. 3.Unidad de Enfermedades InfecciosasHospital Universitario Reina Sofía-IMIBICCórdobaEspaña
  4. 4.Pharmacoeconomics & Outcomes Research IberiaMadridEspaña
  5. 5.Roche Farma S.A.MadridEspaña

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