{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T10:49:52Z","timestamp":1791802192091,"version":"4.3.4"},"reference-count":13,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cytomegalovirus (CMV) reactivation is a major infectious complication following pediatric allogeneic hematopoietic stem cell transplantation (HSCT), particularly in low\u2010 and middle\u2010income countries (LMICs) with high CMV seroprevalence. Data on the clinical and economic impact of letermovir prophylaxis in pediatric HSCT recipients from resource\u2010constrained settings remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cost\u2010effectiveness analysis of pediatric allogeneic HSCT recipients at a university\u2010affiliated tertiary\u2010care transplant center in India. Clinical outcomes and direct medical costs were compared between patients who received letermovir prophylaxis and those managed with a standard pre\u2010emptive CMV strategy. The primary outcome was CMV reactivation by Day +100 post\u2010transplant. Cost\u2010effectiveness was evaluated using the incremental cost\u2010effectiveness ratio (ICER).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifty patients were included, of whom 15 received letermovir prophylaxis and 35 received standard pre\u2010emptive management. By Day +100 post\u2010transplant, CMV reactivation occurred in 26.7% of patients receiving letermovir compared with 91.4% in the non\u2010letermovir group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Median time to CMV reactivation was longer in the letermovir group at 28.5\u2009days versus 18.0\u2009days. No patient in the letermovir group required additional CMV\u2010related hospitalization, whereas 50% of patients in the non\u2010letermovir group required prolonged hospitalization. Mean total treatment costs were higher in the letermovir group at $1868.5 compared with $1698.6 in the non\u2010letermovir group; however, the incremental cost\u2010effectiveness ratio was $262.6 per additional patient without CMV reactivation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite higher upfront costs, letermovir demonstrated favorable cost\u2010effectiveness in pediatric allogeneic HSCT recipients in resource\u2010limited settings, while providing significant clinical benefits through reduced CMV reactivation, delayed breakthrough infection, and decreased CMV\u2010related hospitalization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/petr.70485","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T10:32:55Z","timestamp":1791801175000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Letermovir Prophylaxis in Pediatric Allogeneic Hematopoietic Stem Cell Transplantation: Clinical Effectiveness and Economic Implications"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-8993-5004","authenticated-orcid":false,"given":"Swathi","family":"P. M.","sequence":"first","affiliation":[{"name":"Department of Pediatric Oncology, Kasturba Medical College Manipal Academy of Higher Education  Manipal Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7616-6408","authenticated-orcid":false,"given":"Archana","family":"M. V.","sequence":"additional","affiliation":[{"name":"Department of Pediatric Oncology, Kasturba Medical College Manipal Academy of Higher Education  Manipal Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2891-3392","authenticated-orcid":false,"given":"Nishanth","family":"S.","sequence":"additional","affiliation":[{"name":"Department of Pediatric Oncology, Kasturba Medical College Manipal Academy of Higher Education  Manipal Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2441-6188","authenticated-orcid":false,"given":"Emine A.","family":"Rahiman","sequence":"additional","affiliation":[{"name":"Department of Pediatric Oncology, Kasturba Medical College Manipal Academy of Higher Education  Manipal Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikitha K.","family":"Nekkileru","sequence":"additional","affiliation":[{"name":"Department of Pediatric Oncology, Kasturba Medical College Manipal Academy of Higher Education  Manipal Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3540-2865","authenticated-orcid":false,"given":"Sudheesh","family":"N.","sequence":"additional","affiliation":[{"name":"Manipal Institute of Virology Manipal Academy of Higher Education  Manipal Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1521-6501","authenticated-orcid":false,"given":"Shivdas Rajaram","family":"Naik","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Kasturba Medical College, Manipal Academy of Higher Education  Manipal Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4081-1372","authenticated-orcid":false,"given":"Vasudeva K.","family":"Bhat","sequence":"additional","affiliation":[{"name":"Department of Pediatric Oncology, Kasturba Medical College Manipal Academy of Higher Education  Manipal Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12288\u2010023\u201001654\u20101"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1128\/aac.00420\u201025"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.4103\/ijmm.IJMM_17_269"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.30608"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.21873\/anticanres.15848"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1706640"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtct.2025.05.021"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s41669\u2010023\u201000398\u2010y"},{"key":"e_1_2_12_10_1","volume-title":"PREVYMIS (Letermovir) Tablets, Oral Pellets, and Injection Prescribing Information","author":"U.S. Food and Drug Administration","year":"2025"},{"key":"e_1_2_12_11_1","first-page":"422","volume-title":"Bone Marrow Transplantation","author":"Wang Q.","year":"2025"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/hemato4020013"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/13696998.2020.1843321"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10198\u2010025\u201001890\u20104"}],"container-title":["Pediatric 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