Cost utility analysis of two BK polyomavirus screening strategies: quantitative polymerase chain reaction vs 2-stage approach

Abstract

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. Probabilistic Markov models were constructed to evaluate the incremental costs and benefits of (1) screening with qPCR, (2) 2-stage screening, and (3) no routine viral screening. One-way and probabilistic sensitivity analyses were conducted to define the most influential variables in the model. Screening with either qPCR or 2-stage approaches produce incremental benefit (0.29 and 0.287 quality adjusted life years (QALYs) respectively) and save cost (USD 9,940 and USD11,610), compared with no screening. 2-stage screening associates with cost reduction (USD 1,670) at the expenses of loss in QALY (0.003 QALYs) than screening with qPCR. The incremental cost-effectiveness ratio 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 qPCR or 2-stage approach (urine cytology followed by qPCR test) is cost-saving and improves QALYs. We demonstrated various factors would affect cost efficiency of 2-stage screening vs screening with qPCR. The transplant centre should consider local factors and the willingness to pay to devise the best screening strategy. Not applicable.