Evidence map›Paper›PMID 32712663›Full record

Trial reportClinical infectious diseases : an official publication of the Infectious Diseases Society of America2021

Cost-effectiveness of Preemptive Therapy Versus Prophylaxis in a Randomized Clinical Trial for the Prevention of Cytomegalovirus Disease in Seronegative Liver Transplant Recipients With Seropositive Donors.

Nina Singh, Drew J Winston, Raymund R Razonable, G Marshall Lyon, Fernanda P Silveira, Marilyn M Wagener, Ajit P Limaye

Registry-linked trialOpen access · greenAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06574789 (Individualised Dose Optimisation of Ganciclovir in Immunocompromised Children Trial), which is not on this map. Cited by 9 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 3 pooled it
1.7field-weighted citation impact, top 14% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06574789 phase2recruitingnot on this mapstarted 2024, after this paper: background citation

Individualised Dose Optimisation of Ganciclovir in Immunocompromised Children Trial (ID-MAGIC)

TypeinterventionalSponsorMurdoch Childrens Research InstituteRan2024 to 2028Enrolled232ConditionsCytomegalovirus ViraemiaArmsStandard dosing of IV ganciclovir, Personalised dosing of IV ganciclovir
3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 3 syntheses or guidelines pooled it, 27 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Review
  5. Article
  6. Pre-Transplant Frequencies of FoxP3Transplant international : official journal of the European Society for Organ Transplantation · 2024
    Article
  7. Article
  8. Review
  9. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 6 institutions in 1 country.

Nina SinghUniversity of Pittsburgh and Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.
Drew J WinstonUniversity of California, Los Angeles Medical Center, Los Angeles, California, USA.
Raymund R RazonableMayo Clinic, Rochester, Minnesota, USA.
G Marshall LyonEmory University, Atlanta, Georgia, USA.
Fernanda P SilveiraUniversity of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Marilyn M WagenerUniversity of Pittsburgh and Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.
Ajit P LimayeUniversity of Washington, Seattle, Washington, USA.
University of Pittsburgh · USEmory University · USMayo Clinic · USUniversity of California, Los Angeles · USUniversity of Pittsburgh Medical Center · USUniversity of Washington · US

Funding

NIAID NIH HHS HHSN272201100041C
6 · The paper itself

Abstract

backgroundThe relative costs of preemptive therapy (PET) or prophylaxis for the prevention of cytomegalovirus (CMV) disease in high-risk donor CMV-seropositive/recipient-seronegative (D+/R-) liver transplant recipients have not been assessed in the context of a randomized trial.

methodsA decision tree model was constructed based on the probability of outcomes in a randomized controlled trial that compared valganciclovir as PET or prophylaxis for 100 days in 205 D+/R- liver transplant recipients. Itemized costs for each site were obtained from a federal cost transparency database. Total costs included costs of implementation of the strategy and CMV disease treatment-related costs. Net cost per patient was estimated from the decision tree for each strategy.

resultsPET was associated with a 10% lower absolute rate of CMV disease (9% vs 19%). The cost of treating a case of CMV disease in our patients was $88 190. Considering cost of implementation of strategy and treatment-related cost for CMV disease, the net cost-savings per patient associated with PET was $8707 compared to prophylaxis. PET remained cost-effective across a range of assumptions (varying costs of monitoring and treatment, and rates of disease).

conclusionsPET is the dominant CMV prevention strategy in that it was associated with lower rates of CMV disease and lower overall costs compared to prophylaxis in D+/R- liver transplant recipients. Costs were driven primarily by more hospitalizations and higher CMV disease-associated costs due to delayed onset postprophylaxis disease in the prophylaxis group.

Indexed as

Cytomegalovirus InfectionsLiver TransplantationAntiviral AgentsCost-Benefit AnalysisCytomegalovirusGanciclovirHumansTransplant RecipientsAntiviral AgentsGanciclovirCMVcost-effectivenesscytomegaloviruspreemptive therapytransplant

Identifiers

PMID32712663
PMCPMC8563196
OpenAlexW3045375091

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.