Healthcare resource utilization and costs of letermovir for cytomegalovirus-prophylaxis after allogeneic hematopoietic cell transplantation in a real-world, multi-centre study in Germany

OBJECTIVES: Letermovir has demonstrated efficacy and tolerability as prophylaxis against clinically significant cytomegalovirus infection (csCMVi) in CMV-seropositive adult patients undergoing allogeneic hematopoietic cell transplantation (alloHCT) compared to alternative antivirals. Despite these advantages, associated costs remain substantial. This study addresses the evidence gap by evaluating the health economic impact of CMV prophylaxis with letermovir in a real-world setting for alloHCT patients. METHODS: This retrospective, multi-centre case-control study was conducted at six German tertiary care centres. A micro-costing approach evaluated hospitalisation and anti-CMV drug acquisition costs over a 48-week follow-up period post-alloHCT. The analysis included patients surviving at least 100 days following alloHCT, comparing individuals receiving letermovir prophylaxis (cases) with those who did not (controls) between January 2018 and April 2021. RESULTS: The incidence of csCMVi was significantly higher in the control than in the letermovir group (56%, n = 98 vs. 34%, n = 63, p < 0.001). Median hospital length of stay was significantly longer in the control group (45 days, IQR 36-66) compared to the letermovir group (39 days, IQR 32-55; p < 0.001). Hospitalisation costs were comparable (p = 0.865), while anti-CMV drug acquisition and overall direct treatment costs were significantly higher in the letermovir group (€21,844, 95% CI 19,247 - 25,107 vs. €7,711, 95% CI 12,692 - 25,107, p < 0.001; 81,871, 95% CI 76,721 - 87,021 vs. 67,161, 95% CI 61,693 - 72,629, p < 0.001). Besides letermovir, cost drivers post-alloHCT were rehospitalisation and csCMVi. CONCLUSIONS: Our study demonstrated higher anti-CMV drug acquisition costs and overall direct treatment costs in patients receiving letermovir prophylaxis compared to controls. However, these higher costs are accompanied by significantly improved clinical outcomes.