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Maribavir for treating refractory or resistant cytomegalovirus infection after transplant

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1 Recommendations

1.1 Maribavir is not recommended, within its anticipated marketing authorisation, for treating cytomegalovirus (CMV) infection that is refractory or resistant to treatment including ganciclovir, valganciclovir, cidofovir or foscarnet in adults who have had a haematopoietic stem cell transplant or solid organ transplant.

1.2 This recommendation is not intended to affect treatment with maribavir that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.

Why the committee made these recommendations

Usual treatment for CMV infection after a transplant is ganciclovir, valganciclovir, cidofovir or foscarnet. For infections that come back or do not respond well enough to treatment, the same treatments are available, but different treatments or combinations can be used.

Clinical evidence suggests that maribavir gets rid of CMV infection better than usual treatment, but this is uncertain because of the way the trial was done.

The most likely cost-effectiveness estimates are also uncertain, and are above the range that NICE considers an acceptable use of NHS resources. So maribavir is not recommended.