{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T05:05:12Z","timestamp":1789275912889,"version":"build-2803163510"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T00:00:00Z","timestamp":1789171200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T00:00:00Z","timestamp":1789171200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100004334","name":"Merck","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004334","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["PharmacoEconomics Open"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background\/Objective<\/jats:title>\n                    <jats:p>Cytomegalovirus (CMV) causes serious health problems in people with weakened immune systems, particularly those undergoing kidney transplantation. CMV can severely impact transplant outcomes through increased complications, graft loss, morbidity, and mortality. Valganciclovir (VGCV) is a commonly used prophylaxis after kidney transplantation for high-risk patients, but is known to induce leukopenia\/neutropenia (LN). In the MK-8228-002 phase III trial, letermovir prophylaxis was non-inferior to VGCV for CMV prevention among high-risk adult kidney transplant recipients, but was also associated with significantly lower LN. This study aimed to evaluate the budget impact of introducing letermovir as a CMV prophylaxis drug for kidney transplant patients, with an increasing market share over 5 years compared with a market scenario with VGCV only, from a United States (US) payer perspective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A budget impact analysis was conducted from a US payer perspective, modeling a hypothetical health plan of 1,000,000 members, including 18 high-risk kidney transplant patients per year. The model compared a market scenario with VGCV only (without letermovir) versus a scenario in which letermovir is introduced into a healthcare plan with an increasing market share over 5 years. The model incorporated direct medical costs associated with prophylaxis drug acquisition and administration, LN events, and the downstream effects of LN events (e.g., CMV DNAemia, opportunistic infections, graft rejection\/loss). Modeled outcomes included total budget impact and incremental cost per member per month (PMPM, 2025 USD). One-way sensitivity analysis (OWSA) was also conducted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The annual total costs without letermovir were US$1,628,307 for each year and ranged from US$1,604,558 (year 1) to US$1,596,297 (year 5) in the scenario with letermovir. Incremental PMPM ranged from \u2212\u2009US$0.0020 in year 1 to \u2212\u2009US$0.0027 in year 5, indicating cost savings associated with letermovir in each year. The deterministic sensitivity analysis identified the rate of having LN events on VGCV as the most influential driver of the budget impact results, followed by the annual management cost of LN events and LN-associated events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This analysis provides evidence on the potential impact of introducing letermovir into the US market. While the acquisition cost of letermovir is higher than that of VGCV, there are estimated cost savings, primarily driven by the prevention of LN events and their associated downstream clinical consequences, suggesting that the savings from LN avoidance outweigh the incremental prophylaxis costs of introducing letermovir. However, the overall budget impact remains minimal and should be interpreted in the context of the evolving evidence base.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s41669-026-00679-2","type":"journal-article","created":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T15:56:23Z","timestamp":1789228583000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Budget Impact of Prophylactic Letermovir to Prevent Cytomegalovirus Disease in High-Risk Adult Kidney Transplant Recipients"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-1629-1991","authenticated-orcid":false,"given":"Murvin","family":"Jootun","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina","family":"Kolobova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vladimir","family":"Turzhitsky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Ai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qinghua","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Wong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdel","family":"Hmissi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Beyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,12]]},"reference":[{"key":"679_CR1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.13512","volume":"33","author":"RR Razonable","year":"2019","unstructured":"Razonable RR, Humar A. Cytomegalovirus in solid organ transplant recipients-guidelines of the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019;33:e13512. https:\/\/doi.org\/10.1111\/ctr.13512.","journal-title":"Clin Transplant"},{"key":"679_CR2","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1590\/s1679-45082015rw3175","volume":"13","author":"LR Requi\u00e3o-Moura","year":"2015","unstructured":"Requi\u00e3o-Moura LR, deMatos AC, Pacheco-Silva A. Cytomegalovirus infection in renal transplantation: clinical aspects, management and the perspectives. Einstein (Sao Paulo). 2015;13:142\u20138. https:\/\/doi.org\/10.1590\/s1679-45082015rw3175.","journal-title":"Einstein (Sao Paulo)"},{"key":"679_CR3","doi-asserted-by":"publisher","first-page":"71","DOI":"10.25122\/jml-2021-0209","volume":"15","author":"MYN Al Atbee","year":"2022","unstructured":"Al Atbee MYN, Tuama HS. Cytomegalovirus infection after renal transplantation. J Med Life. 2022;15:71\u20137. https:\/\/doi.org\/10.25122\/jml-2021-0209.","journal-title":"J Med Life"},{"key":"679_CR4","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1186\/s12879-017-2599-y","volume":"17","author":"LA Selvey","year":"2017","unstructured":"Selvey LA, et al. Cytomegalovirus viraemia and mortality in renal transplant recipients in the era of antiviral prophylaxis. Lessons from the western Australian experience. BMC Infect Dis. 2017;17:501. https:\/\/doi.org\/10.1186\/s12879-017-2599-y.","journal-title":"BMC Infect Dis"},{"key":"679_CR5","doi-asserted-by":"publisher","first-page":"3333","DOI":"10.7150\/ijms.62621","volume":"18","author":"SH Han","year":"2021","unstructured":"Han SH, et al. The incidence and effect of cytomegalovirus disease on mortality in transplant recipients and general population: real-world nationwide cohort data. Int J Med Sci. 2021;18:3333\u201341. https:\/\/doi.org\/10.7150\/ijms.62621.","journal-title":"Int J Med Sci"},{"key":"679_CR6","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1093\/cid\/ciw668","volume":"64","author":"P Ljungman","year":"2017","unstructured":"Ljungman P, et al. Definitions of cytomegalovirus infection and disease in transplant patients for use in clinical trials. Clin Infect Dis. 2017;64:87\u201391. https:\/\/doi.org\/10.1093\/cid\/ciw668.","journal-title":"Clin Infect Dis"},{"key":"679_CR7","doi-asserted-by":"publisher","first-page":"596","DOI":"10.1086\/318724","volume":"32","author":"CV Paya","year":"2001","unstructured":"Paya CV. Prevention of cytomegalovirus disease in recipients of solid-organ transplants. Clin Infect Dis. 2001;32:596\u2013603. https:\/\/doi.org\/10.1086\/318724.","journal-title":"Clin Infect Dis"},{"key":"679_CR8","doi-asserted-by":"publisher","first-page":"1481","DOI":"10.2147\/IDR.S180908","volume":"12","author":"G El Helou","year":"2019","unstructured":"El Helou G, Razonable RR. Letermovir for the prevention of cytomegalovirus infection and disease in transplant recipients: an evidence-based review. Infect Drug Resist. 2019;12:1481\u201391. https:\/\/doi.org\/10.2147\/IDR.S180908.","journal-title":"Infect Drug Resist"},{"key":"679_CR9","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1111\/j.1399-3062.2009.00372.x","volume":"11","author":"RA Fisher","year":"2009","unstructured":"Fisher RA. Cytomegalovirus infection and disease in the new era of immunosuppression following solid organ transplantation. Transpl Infect Dis. 2009;11:195\u2013202. https:\/\/doi.org\/10.1111\/j.1399-3062.2009.00372.x.","journal-title":"Transpl Infect Dis"},{"key":"679_CR10","doi-asserted-by":"publisher","first-page":"1091","DOI":"10.1097\/TP.0b013e3181f7c053","volume":"90","author":"HT Kuo","year":"2010","unstructured":"Kuo HT, Ye X, Sampaio MS, Reddy P, Bunnapradist S. Cytomegalovirus serostatus pairing and deceased donor kidney transplant outcomes in adult recipients with antiviral prophylaxis. Transplantation. 2010;90:1091\u20138. https:\/\/doi.org\/10.1097\/TP.0b013e3181f7c053.","journal-title":"Transplantation"},{"key":"679_CR11","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1038\/ki.2009.377","volume":"77","author":"BL Kasiske","year":"2010","unstructured":"Kasiske BL, et al. KDIGO clinical practice guideline for the care of kidney transplant recipients: a summary. Kidney Int. 2010;77:299\u2013311. https:\/\/doi.org\/10.1038\/ki.2009.377.","journal-title":"Kidney Int"},{"key":"679_CR12","doi-asserted-by":"publisher","first-page":"900","DOI":"10.1097\/TP.0000000000002191","volume":"102","author":"CN Kotton","year":"2018","unstructured":"Kotton CN, et al. The third international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation. Transplantation. 2018;102:900\u201331. https:\/\/doi.org\/10.1097\/TP.0000000000002191.","journal-title":"Transplantation"},{"key":"679_CR13","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1001\/jama.2023.9106","volume":"330","author":"AP Limaye","year":"2023","unstructured":"Limaye AP, et al. Letermovir vs valganciclovir for prophylaxis of cytomegalovirus in high-risk kidney transplant recipients: a randomized clinical trial. JAMA. 2023;330:33\u201342. https:\/\/doi.org\/10.1001\/jama.2023.9106.","journal-title":"JAMA"},{"key":"679_CR14","unstructured":"U.S. Bureau of Labor Statistics. Consumer Price Index (ed United States Department of Labor). 2026. https:\/\/www.bls.gov\/cpi\/"},{"key":"679_CR15","unstructured":"Organ Procurement & Transplantation Network. https:\/\/optn.transplant.hrsa.gov\/data\/view-data-reports\/national-data\/. Accessed 5 Oct 2022."},{"key":"679_CR16","unstructured":"United States Census Bureau. https:\/\/www.census.gov\/quickfacts\/fact\/table\/US. Accessed 5 Oct 2022."},{"key":"679_CR17","doi-asserted-by":"publisher","DOI":"10.1097\/TXD.0000000000001147","volume":"7","author":"MR Jorgenson","year":"2021","unstructured":"Jorgenson MR, et al. Geographic distribution of cytomegalovirus serology in kidney and pancreas transplant recipients in the United States. Transplant Direct. 2021;7:e704. https:\/\/doi.org\/10.1097\/TXD.0000000000001147.","journal-title":"Transplant Direct"},{"key":"679_CR18","unstructured":"AnalySource. Premier Drug Pricing Services, www.analysource.com. Accessed 5 Sept 2023."},{"key":"679_CR19","unstructured":"Kaiser-Family-Foundation. Average cost of inpatient day at U.S. hospitals in 2021, by hospital type. https:\/\/www.statista.com\/statistics\/630443\/inpatient-day-hospital-costs-in-us-by-nonprofit-or-profit\/. Accessed 25 Sept 2021."},{"key":"679_CR20","unstructured":"Sidecar-Health. Cost of nephrologist visit by state. <https:\/\/cost.sidecarhealth.com\/c\/nephrologist-visit-cost. Accessed 22 Sept 2023."},{"key":"679_CR21","doi-asserted-by":"publisher","first-page":"155","DOI":"10.36469\/001c.159410","volume":"13","author":"V Turzhitsky","year":"2026","unstructured":"Turzhitsky V, Li Q, Ai L, Jootun M, Wang W, Beyer A, et al. Short and long-term outcomes in kidney transplant recipients with neutropenia or leukopenia following CMV prophylaxis. J Health Econ Outcomes Res. 2026;13:155\u201367. https:\/\/doi.org\/10.36469\/001c.159410.","journal-title":"J Health Econ Outcomes Res"},{"key":"679_CR22","unstructured":"Turzhitsky V, Raval A, Moise P, Merchant S. Abstract FR-PO829. Healthcare utilization and costs associated with neutropenia\/leukopenia in kidney transplant recipients receiving valganciclovir prophylaxis: an administrative claims database study. In: Presented at ASN Kidney Week 2022; Orlando, FL, USA; November 3-6, 2022."},{"key":"679_CR23","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1007\/s41669-023-00398-y","volume":"7","author":"A Sepassi","year":"2023","unstructured":"Sepassi A, et al. Cost effectiveness of letermovir for cytomegalovirus prophylaxis compared with pre-emptive therapy in allogeneic hematopoietic stem cell transplant recipients in the United States. Pharmacoecon Open. 2023;7:393\u2013404. https:\/\/doi.org\/10.1007\/s41669-023-00398-y.","journal-title":"Pharmacoecon Open"},{"key":"679_CR24","doi-asserted-by":"publisher","first-page":"S111","DOI":"10.1016\/j.jval.2021.04.590","volume":"24","author":"A Alsumali","year":"2021","unstructured":"Alsumali A, Raval A, Tang Y. PIN31 budget-IMPACT analysis of letermovir for preventing cytomegalovirus in adult cytomegalovirus seropositive allogeneic hematopoietic cell transplant recipients in the United States. Value Health. 2021;24:S111. https:\/\/doi.org\/10.1016\/j.jval.2021.04.590.","journal-title":"Value Health"}],"container-title":["PharmacoEconomics - Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s41669-026-00679-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s41669-026-00679-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s41669-026-00679-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T04:32:36Z","timestamp":1789273956000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s41669-026-00679-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,12]]},"references-count":24,"alternative-id":["679"],"URL":"https:\/\/doi.org\/10.1007\/s41669-026-00679-2","relation":{},"ISSN":["2509-4262","2509-4254"],"issn-type":[{"value":"2509-4262","type":"print"},{"value":"2509-4254","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,12]]},"assertion":[{"value":"9 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 September 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors of this work are or were at the time of its completion employees of Merck.","order":1,"name":"Ethics","label":"Conflict of Interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This work is an economic model and did not involve human participants, human data, or human tissue. The analysis of an anonymized administrative dataset used to derive some inputs also does not qualify as human subject research as per the US Food and Drug Administration Policy for the Protection of Human Subjects. Therefore, there was no requirement for ethics or Institutional Review Board review, and there was no attempt to seek informed consent.","order":2,"name":"Ethics","label":"Ethical Approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":3,"name":"Ethics","label":"Consent for Publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The datasets used and\/or analyzed during the current study are available from the corresponding author on reasonable request.","order":4,"name":"Ethics","label":"Availability of Data and Materials","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The model underlying this analysis is proprietary and contains confidential information. Access to the code may be made available from the authors upon reasonable request, subject to appropriate data-sharing agreements and permissions.","order":5,"name":"Ethics","label":"Code Availability","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":6,"name":"Ethics","label":"Consent to Participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All authors contributed equally to this work. All authors were involved in the conceptualization and development of the economic model, as well as in the interpretation of the findings. All authors contributed to drafting the manuscript and approved the final version.","order":7,"name":"Ethics","label":"Author Contributions","group":{"name":"EthicsHeading","label":"Declarations"}}]}}