Product information and disease description Place of product in therapy Disease description Burden of Refractory mucocutaneous herpes simplex virus infection in immunocompromised adults

Economic burden and healthcare resource utilization

7 evidence topics · 6 sources

Cost-of-illness, claims-based cost, and length-of-stay studies of refractory or resistant infection

No evidence found.

Resource use and cost left unquantified in the seven-center United States transplant cohort

“Health care resource utilization and costs associated with foscarnet were beyond the scope of this study but should be quantified in future studies” (opens the source at this quote in a new tab)

Hospitalization in the single-center United States transplant cohort of 18 recipients

“Complications derived from acyclovir-resistant HSV infection and its treatment included hospitalization in nine (50%) patients” (opens the source at this quote in a new tab)

Setting and duration of second-line therapy in the seven-center United States transplant cohort

“A total of 110 patients (88%) received second line therapy(ies), including foscarnet (94), intravenous cidofovir (6), and/or topical antivirals (21).” (opens the source at this quote in a new tab)
“Ninety-four patients received foscarnet, 6 received IV cidofovir, and 21 received topical antivirals for a total of 109 foscarnet courses, 6 IV cidofovir courses, and 28 topical antiviral courses.” (opens the source at this quote in a new tab)
“The treatment duration was a mean (SD) of 21.8 (13.8), 20.3 (10.1), and 41.0 (37.5) days for foscarnet, IV cidofovir, and topical antivirals, respectively.” (opens the source at this quote in a new tab)
“Foscarnet was the most common second-line therapy, administered in a health care setting (hospital and/or hospital-associated infusion clinic) for a mean duration of 21.8 days.” (opens the source at this quote in a new tab)
“The number of antiviral courses and duration of exposure highlight the burden of therapy for refractory HSV infections.” (opens the source at this quote in a new tab)

Intravenous administration and hospitalization required for foscarnet and cidofovir

“Foscarnet requires daily IV administration; consequently, initiation of foscarnet may be deferred until the lesions worsen and/or hospitalization is deemed necessary based on physician judgment and patient preferences. Systemic cidofovir requires weekly IV administration and, although it could theoretically be given in the outpatient setting, concerns for nephrotoxicity and limited efficacy data hinder its applicability for refractory HSV.” (opens the source at this quote in a new tab)

“The need for frequent intravenous delivery and hydration, coupled with the electrolyte monitoring and repletion requirements of foscarnet, typically require hospitalization for initiation, which can be prolonged for some individuals.” (opens the source at this quote in a new tab)
“The median duration of foscarnet therapy was 16 days (range, 6–85 days).” (opens the source at this quote in a new tab)
“Monitoring of renal function and electrolytes at least 2–3 times a week, vigorous hydration, and electrolyte repletion are necessary and require clinicians to be vigilant, especially when foscarnet is administered in the outpatient setting.” (opens the source at this quote in a new tab)

Compounded topical cidofovir: pharmacy logistics and cost as described in a single-center series

“topical cidofovir use was limited by logistic difficulties, as it requires a compounding specialty pharmacy, and it is not cost-effective for patients with large (i.e., more than a few centimeters) mucocutaneous lesions.” (opens the source at this quote in a new tab)

Escalation to second-line and intravenous therapy in a United States claims-linked cohort of 152,835 people with diagnosed infection

“Retrospective cohort study using linked U.S. EHR and administrative claims data (HealthVerity, Inovalon closed claims, Arcadia EHR) from Jan 1, 2022–Dec 31, 2024.” (opens the source at this quote in a new tab)
“Upward dose titration occurred in 7.6% (n=9,138), switching between first-line agents in 11.8% (n=14,196), and route changes in 5.3% (n=6,367); escalation from first-line to second-line therapy agents occurred in 1% (n=1,247) (Figure 2).” (opens the source at this quote in a new tab)
“These patterns were proxies, not confirmation of R±R HSV.” (opens the source at this quote in a new tab)
“Overall, 2,110 (20.3%) IC patients exhibited at least one treatment-change pattern (HCT: n=138; SOT: n=130; PLWH: n=612; IC Rx: n=1,230).” (opens the source at this quote in a new tab)
“Among patients treated with IV therapy (n=443), 40% (n=179) experienced at least one AE within 30 days.” (opens the source at this quote in a new tab)

Proxy evidence: outpatient foscarnet days in transplant recipients treated for cytomegalovirus or human herpesvirus 6

“This retrospective, single-center, observational study at Stanford University Medical Center assessed HCT recipients who received foscarnet between January 2009 and May 2019.” (opens the source at this quote in a new tab)
“The average duration of outpatient antiviral days for the continuous infusion group was 9 days (range, 0 to 121 days), compared with 6.3 days (range, 0 to 70 days) in the intermittent infusion group (P = .54).” (opens the source at this quote in a new tab)
“Administering foscarnet as a continuous infusion is a feasible option to facilitate outpatient treatment.” (opens the source at this quote in a new tab)