Introduction

Conventional anti-cytomegalovirus (CMV) therapies for hematopoietic cell and solid organ transplant (HCT/SOT) recipients can be associated with drug resistance and treatment failure. We report post-transplant CMV treatment patterns and costs of current anti-CMV drugs to investigate the healthcare burden.

Methods

IBM MarketScan^® claims were retrospectively identified January 2013–December 2019 for SOT/HCT recipients with CMV diagnosis continuously enrolled in a health insurance plan. Patients were followed until March 2020 or end of continuous enrollment. Index date was date of first CMV diagnosis claim. Exploratory analyses included anti-CMV drug use pre-index (≥1 day on anti-CMV drug between transplant and index date) and post-index, and treatment costs to payers.

Results

Overall, 1,085 patients were identified (HCT, 27.5%; SOT, 72.5%); 778 (71.7%) patients had pre-index anti-CMV drug use, of whom 721 (92.7%) received one drug, commonly valganciclovir (n=654, 90.7%). Median time (days [IQR]) to first CMV diagnosis claim was 156 (60–273) and longer in patients with pre-index anti-CMV drug use (187 [103–285]) than without (51 [23–181]). Overall, 78.5% (n=852) patients had post-index anti-CMV drug use. Median time to first post-index anti-CMV drug use after diagnosis claim: 7 days (IQR, 1–22). For patients with post-index anti-CMV drug use, most common initial treatment patterns were valganciclovir only (n=483, 56.7%), ganciclovir/valganciclovir switching (n=151, 17.7%), ganciclovir only (n=95, 11.2%), other combination (n=80, 9.4%); 30-day standardized median treatment costs per treated patient were $2895, $2584, $2837, $5452, respectively.

Conclusions

Most patients had pre-index anti-CMV drug use, suggesting prophylaxis/pre-emptive therapy, delaying CMV development compared with no therapy. Valganciclovir was commonly used post-diagnosis. Of the most commonly used initial treatment patterns, “other combination” had higher costs. Further research to quantify the total costs for patients with each treatment pattern and their clinical profile, including outcomes, is needed.

Funding

Takeda Development Center Americas Inc.