{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T13:26:19Z","timestamp":1793366779398,"version":"4.5.0"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2020,7,27]],"date-time":"2020-07-27T00:00:00Z","timestamp":1595808000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["HHSN272201100041C"],"award-info":[{"award-number":["HHSN272201100041C"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,11,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The 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\u2212) liver transplant recipients have not been assessed in the context of a randomized trial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A 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\u2212 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>PET 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).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>PET 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\u2212 liver transplant recipients. Costs were driven primarily by more hospitalizations and higher CMV disease\u2013associated costs due to delayed onset postprophylaxis disease in the prophylaxis group.<\/jats:p><\/jats:sec>","DOI":"10.1093\/cid\/ciaa1051","type":"journal-article","created":{"date-parts":[[2020,7,22]],"date-time":"2020-07-22T19:22:47Z","timestamp":1595445767000},"page":"e2739-e2745","source":"Crossref","is-referenced-by-count":27,"title":["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"],"prefix":"10.1093","volume":"73","author":[{"given":"Nina","family":"Singh","sequence":"first","affiliation":[{"name":"University of Pittsburgh and Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Drew 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Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajit P","family":"Limaye","sequence":"additional","affiliation":[{"name":"University of Washington, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,7,27]]},"reference":[{"key":"2021110300070340200_CIT0001","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1007\/s00430-007-0066-x","article-title":"The history of cytomegalovirus and its diseases","volume":"197","author":"Ho","year":"2008","journal-title":"Med Microbiol Immunol"},{"key":"2021110300070340200_CIT0002","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1111\/1469-0691.12594","article-title":"Cytomegalovirus infection in solid organ transplant recipients","volume":"20","author":"Lumbreras","year":"2014","journal-title":"Clin Microbiol 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