BACKGROUND: Cytomegalovirus (CMV) is a common complication post-transplant. Available anti-CMV treatments are limited due to complications of toxicities and the development of refractory/resistant CMV, leading to a higher risk of poor clinical outcomes, including graft failure and mortality. Currently, evidence is limited on the health-related quality of life (HRQoL) of people living with refractory/resistant CMV post-transplant.

OBJECTIVES: The aim of this study was to estimate health-state utility values (HSUVs) for people with refractory/resistant CMV following solid-organ/hematopoietic-cell transplant (SOT/HCT) via an online composite time trade-off (TTO) valuation study involving the UK general public.

METHODS: Vignette development was informed by a review of existing materials on CMV and qualitative interviews with five UK-based clinicians. Vignettes described three clinical states of refractory/resistant CMV: clinically significant and symptomatic (CS-sCMV), clinically significant and asymptomatic (CS-aCMV), and non-clinically significant (N-csCMV). Each clinical state was evaluated independently and combined with three separate events of interest: graft-versus-host disease, kidney graft loss, and lung graft loss. Overall, 1020 respondents from the UK general public validated the 12 vignettes via online TTO survey. To ensure data quality, exclusion criteria were applied, removing responders who did not complete the survey within the set time, or who provided illogical responses. The final data analysis was based on 738 unique respondents’ valuations.

RESULTS: N-csCMV had the highest mean HSUV of 0.815 (SD:0.331) followed by CS-aCMV (0.635 [SD:0.468]) and CS-sCMV (0.443 [SD:0.538]). CS-sCMV with lung graft loss had the lowest mean HSUV of 0.289 (SD:0.613), with none of the health states considered worse than dead. HSUVs increased as expected for health states considered less severe.

CONCLUSIONS: HSUVs demonstrated that refractory/resistant CMV is a substantial burden on post-transplant patient HRQoL. These utility values may help to support future economic evaluations of therapies for refractory/resistant CMV.