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Published on: May 27, 2011
Pre-emptive virology screening in the pediatric hematopoietic stem cell transplant population: a cost effectiveness
1University of Washington School of Medicine, Department of Pediatrics, United States.
Insights
Proactive screening and treatment for cytomegalovirus (CMV) and Epstein-Barr virus (EBV) in pediatric hematopoietic stem cell transplant (HSCT) patients is cost-effective. This pre-emptive model saves money and improves survival compared to delayed treatment.
Area of Science:
- Hematology
- Infectious Diseases
- Health Economics
Background:
- Pediatric hematopoietic stem cell transplant (HSCT) patients face high risks of cytomegalovirus (CMV) and Epstein-Barr virus (EBV) infections.
- A pre-emptive treatment model, involving routine screening and early intervention for viremia, has shown improved survival over symptomatic treatment.
- This study evaluates the cost-effectiveness of the pre-emptive model in pediatric HSCT.
Purpose of the Study:
- To analyze the cost-effectiveness of a pre-emptive treatment model for CMV and EBV infections in pediatric HSCT patients.
- To compare the cost per quality-adjusted life year (QALY) between pre-emptive and deferred treatment strategies.
Main Methods:
- Retrospective cohort study of 96 pediatric HSCT patients (2006-2010).
- Development of two decision-tree models comparing pre-emptive and deferred treatment strategies.
- Cost and probability data derived from literature and the study cohort.
Main Results:
- The pre-emptive model yielded a 71% five-year survival rate.
- Viremia rates were 4% for EBV and 33% for CMV in the pre-emptive group.
- The pre-emptive model demonstrated cost savings of $2367 per QALY compared to the deferred model.
Conclusions:
- The pre-emptive screening and treatment model is financially viable for pediatric HSCT patients.
- Scheduled screening for subclinical viremia is prudent for optimizing outcomes cost-effectively.
- This approach supports better patient care and resource allocation in pediatric HSCT programs.
Background And Objectives:
Pediatric patients undergoing hematopoietic stem cell transplant (HSCT) are at a uniquely high risk of cytomegalovirus (CMV) and Epstein-Barr virus (EBV) infections. The pre-emptive treatment model whereby asymptomatic post-transplant patients are routinely screened with treatment initiated if found viremic has recently been shown to be superior in terms of patient mortality when compared to deferring laboratory assessment and treatment until symptoms emerge. This study analyzes the cost-effectiveness of the pre-emptive therapy model in patient care dollars per quality-adjusted life years (QALY).
Patients And Methods:
Utilization and outcome data were compiled as a retrospective cohort study of 96 pediatric patients receiving HSCT at University of California Los Angeles Pediatric Hematology/Oncology Department between the years 2006 and 2010. Two-decision tree models were constructed for each the pre-emptive model and the deferred model wherein costs and probability assumptions were based on either previously published literature or calculated from this study cohort.
Results:
The pre-emptive model resulted in a five-year survival of 71%, during which time 4% of patients were found to be EBV viremic, while 33% were found to be CMV viremic. The average actual cost of EBV/CMV virology screening per patient in the cohort following the pre-emptive model was $9699 while the expected cost following the deferred model was $19,284. This results in an incremental cost effectiveness ratio illustrating pre-emptive model cost-savings of $2367/QALY.
Conclusion:
These results support the financial viability and prudence of scheduled screening for subclinical viremia for achieving optimal outcomes in a cost-effective manner in the pediatric HSCT population.
