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Abstract: FR-PO829

Healthcare Utilization and Costs Associated With Neutropenia in Kidney Transplant Recipients Receiving Valganciclovir Prophylaxis: An Administrative Claims Database Study

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical


  • Turzhitsky, Vladimir, Merck & Co., Inc., Rahway, New Jersey, United States
  • Raval, Amit, Merck & Co., Inc., Rahway, New Jersey, United States
  • Moise, Pamela, Merck & Co., Inc., Rahway, New Jersey, United States
  • Merchant, Sanjay, Merck & Co., Inc., Rahway, New Jersey, United States

Kidney transplant recipients (KTRs) who have a D+/R- or R+ cytomegalovirus (CMV) IgG status receive valganciclovir (VGCV) as CMV prophylaxis. However, VGCV is myelosuppressive and may cause medically significant neutropenia. In this study, we evaluate healthcare resource use (HCRU) and cost in KTRs who develop neutropenia on VGCV.


KTRs between 1/1/2012 - 12/31/2018 from IBM Marketscan Commercial and Medicare Supplemental claims databases were included if they had 1 year of continuous enrollment before (baseline) and after (follow-up) their kidney transplant (KT). KTRs with VGCV prescription fills of 450mg or 900 mg/day within 30 days of KT were included in the cohort. Neutropenia was identified as either one inpatient or two outpatient claims separated by 14 or fewer days based on ICD-9/10 codes (288.0x/D70.x). HCRU and cost was evaluated for emergency department (ED), inpatient (IP), outpatient (OP), and pharmacy use.


3,258 (66%) of KTRs with requisite enrollment requirements met the VGCV inclusion criteria. Baseline demographics, HCRU, and cost between the neutropenic and non-neutropenic KTRs were similar. KTRs with neutropenia had significantly higher number of ED visits, other outpatient visits, and hospitalizations compared to those without neutropenia (Table 1). Healthcare costs were significantly higher among KTRs with neutropenia compared to those without neutropenia. Similar trends were observed for leukopenia.


Neutropenia in KTRs is associated with significantly higher HCRU and cost. We hypothesize that strategies aimed at mitigating the development of neutropenia in this immunosuppressed population may also decrease economic burden. These may include investigating less myelotoxic alternatives for CMV prophylaxis. Future studies are needed to further evaluate clinical outcome impacts of such practices.

Table 1. HCRU and costs in the follow-up year.


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