B360 - Cost Associated with Healthcare Resource Utilization Reduced with Letermovir vs Valganciclovir for Cytomegalovirus Prophylaxis in High-Risk Liver Transplant Recipients

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Author Block: H. Kleiboeker¹, J. Fose², C. Saddler², D. Al-Adra², J. Rice², M. Jorgenson³, ¹Pharmacy, University of Wisconsin Hospital and Clinics, Madison, WI, ²University of Wisconsin Hospital and Clinics, Madison, WI, ³University of Wisconsin Health, Madison, WI
*Purpose: Disparity in average wholesale price (AWP) between valganciclovir (VGC) and letermovir (LTV) has spurred concerns regarding financial impact. Cost-effectiveness of LTV has been shown in stem cell transplant recipients; similar analyses have not been conducted in solid organ transplant (SOT) recipients, likely due to slow adoption and channeling bias. The purpose of this study is to evaluate gross cost associated with healthcare resource utilization (HCRU) between LTV and VGC during the prophylaxis period.
*Methods: Adult patients who received a D+/R- liver transplant between 6/1/2021-6/6/2024 were included. The CMV agent of choice at our center changed from VGC to LTV on 6/6/23, as previously described. Patients were assigned based on era and coverage. The primary objective was to compare the financial impact of HCRU associated with CMV management in the first 6 months post-transplant. HCRU included all interventions assessed beyond de novo antiviral prophylaxis.
*Results: Sixty-one patients were included: 35 in VGC cohort and 24 in LTV cohort. Clinical outcomes were previously reported, demonstrating comparable efficacy and improved tolerability. The model was constructed based on end points identified in this study and included costs incurred by the transplant center and healthcare system related to CMV management including drug dose adjustments, preemptive monitoring, GCSF and inpatient admission. Mean cost of HCRU was significantly reduced in the LTV cohort compared to VGC ($9,817.24 vs $17,264.65, p=0.0027).
*Conclusions: Using a small population of high-risk LTRs receiving de novo LTV at our center, cost burden associated with HCRU during prophylaxis was significantly reduced compared to VGC. While AWP of LTV is currently higher than VGC, a comparison evaluating drug cost alone is inadequate and true cost effectiveness of LTV after SOT remains largely unknown. The US healthcare payor model is complex given the mix of payers and separation of medical and pharmacy benefits. In this payor model, much of the financial impact of LTV seems to be borne by prescription insurance companies while the burden on the transplant center and healthcare system is reduced. Future large-scale cost-effectiveness analyses are needed as more outcome data is accumulated.