Authors (including presenting author) :
Ma MKM(1), Chan JFW (2), Ho ETL(3), Lam DCK(4), Lee W(5), Sin HK(6), Szeto CC(7), Wong CK(8), Tang SCW(1)
Affiliation :
(1) Department of Medicine, Queen Mary Hospital, (2) Department of Microbiology, the University of Hong Kong, (3) Department of Medicine, Tseung Kwan O Hospital, (4) Department of Medicine and Geriatrics, United Christian Hospital, (5) Department of Medicine and Geriatrics, Princess Margaret Hospital, (6) Department of Medicine and Geriatrics, Kwong Wah Hospital, (7) Department of Medicine and Therapeutics, Prince of Wales Hospital, (8) Department of Medicine, Pamela Youde Nethersole Eastern Hospital
Keyword 1: :
Kidney Transpplantation
Keyword 4: :
economic analysis
Introduction :
Screening for BK polyomavirus (BKPyV) with quantitative polymerase chain reaction (qPCR) or a 2-stage approach with urine cytology followed by qPCR are acceptable strategies. However, the magnitude of the health benefits and incremental cost of adopting these 2 screening strategies are largely unknown.
Objectives :
To evaluate the magnitude of the health benefits and incremental cost of adopting (1) screening with qPCR, (2) 2-stage screening, and (3) no routine viral screening
Methodology :
Probabilistic Markov models were constructed to evaluate the incremental costs and benefits of the two screening strategies. One-way and probabilistic sensitivity analyses were conducted to define the most influential variables in the model.
Result & Outcome :
Compared with no screening, the incremental benefits of screening were 0.29 and 0.287 quality adjusted life years (QALYs) gain for the qPCR and 2-stage approaches, respectively. The total savings from screening were HKD 77,532 and HKD 90,558 for the qPCR and 2-stage approaches, respectively. incremental cost-effectiveness ratio (ICER) of screening with qPCR saves HKD 267,353/QALY, and the 2-stage approach saves HKD 315, 533/QALY The ICER of the models was sensitive to the graft survival rate and patient survival rate, incidence of BKPyV-DNAaemia, probability of transplantation, sensitivity and cost of urine cytology and qPCR. Screening with 2-stage screening was the best strategy in terms of net monetary benefit across a range of ‘willingness-to-pay’. From the healthcare provider’s perspective, routine BKPyV screening with either qPRC or 2-stage approach (urine cytology followed by qPCR test) is cost-saving and improves QALYs. Compared with the 2-stage approach, screening with qPCR provides a small net improvement in QALYs at a greater cost. The transplant centre should consider local factors, such as patient and graft survival rate, incident rate of BKPyV-DNAaemia, re-transplant rate, test performance and cost of qPCR and urine cytology, and the willingness to pay to devise the best screening strategy.
