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Resource utilization of cytomegalovirus immune globulin in prevention and treatment of cytomegalovirus infection in pediatric heart transplantation
Author(s) -
AsanteKorang Alfred,
Carapellucci Jennifer,
Krasnopero Diane,
Brown Brian,
Kiskaddon Amy,
Wisotzkey Bethany,
Blyumin Gabriella,
Berman David M.,
Namtu Katie
Publication year - 2019
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13750
Subject(s) - medicine , cohort , cytomegalovirus , discontinuation , retrospective cohort study , transplantation , human cytomegalovirus , cohort study , immunology , viral disease , herpesviridae , human immunodeficiency virus (hiv) , virus
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.