TABLE 10.

Consensus recommendations: cost–benefit considerations

• We recommend routine screening for BKPyV-DNAemia using the strategies proposed in this current guideline because it is associated with an improvement in clinical outcomes and is cost-effective in kidney transplant recipients in robust models up to the seventh decade of life (strong, B)

• We suggest not decreasing the frequency of screening because it may reduce the efficacy of intervention by reducing immunosuppression, thereby increasing the overall direct healthcare costs (weak, B)

Future directions

➢ Evaluate different screening strategies (modality and frequency) on cost-effectiveness, particularly because they relate to different geographic areas, ethnicities, and limited access to laboratory testing

➢ Determine the cost-effectiveness ratio of duration and frequency of monitoring of patients not clearing BKPyV-DNAemia at the lowest possible level of immunosuppression (persistent low plasma viral loads with or without biopsy-proven BKPyV-nephropathy)

➢ Evaluate the cost-effectiveness ratio of BKPyV-specific immunity, such as serotype-specific antibodies, neutralizing antibodies, or CMI, to shorten or extend screening for BKPyV-DNAemia

➢ Evaluate the cost-effectiveness ratio of novel interventions such as neutralizing antibodies, novel antivirals, or adoptive T-cell therapies for prevention and therapy of BKPyV-DNAemia/-nephropathy

➢ Assess the benefits of customized screening strategies based on immunosuppression exposure, including choice of induction agent and need for additional therapy for desensitization

BKPyV, BK polyomavirus; CMI, cell-mediated immunity.