Cost-utility and budget impact analyses of valganciclovir for cytomegalovirus retinitis in patients with human immunodeficiency virus in Thailand.

Background: Cytomegalovirus retinitis (CMVR) is an opportunistic infection frequently seen in people living with HIV (PLHIV) and can cause blindness. Intravenous (IV) ganciclovir is a typical CMVR treatment in Thailand, but oral valganciclovir is a more convenient alternative. However, its cost-effectiveness and budget impact remain unclear. Therefore, this study aimed to analyse the cost-utility and budget impact of oral valganciclovir compared with IV ganciclovir for CMVR treatment in PLHIV in Thailand.

Methods: A hybrid decision tree/Markov model was developed to estimate costs, quality-adjusted life years (QALYs), and life years (LYs). Cost, utility, and probability parameters were obtained from the published literature and national databases. A cost-utility analysis was performed to estimate the incremental cost-effectiveness ratios, whereas a budget impact analysis (BIA) was performed to assess the financial implications. Sensitivity analyses were performed to assess model uncertainty.

Results: Oral valganciclovir was the dominant treatment, providing higher QALYs (3.50 vs. 3.23) and LYs (4.78 vs. 4.75) and lower total costs (133,630 THB vs. 163,024 THB) than IV ganciclovir. One-way sensitivity analysis revealed that retinal detachment probability, drug cost, and inpatient service cost were the most influential parameters. Probabilistic sensitivity analysis revealed that 94.3% of the simulations placed oral valganciclovir in the dominant quadrant. BIA revealed an annual cost reduction of 6,408,714 THB when replacing IV ganciclovir with oral valganciclovir.

Conclusion: Oral valganciclovir was cost-effective and demonstrated budget reduction compared with IV ganciclovir. These findings provide valuable insights into enhancing CMVR management and ensuring efficient healthcare resource allocation.