Cost utility analysis of two BK polyomavirus screening strategies: quantitative polymerase chain reaction vs 2-stage approach
8 affiliations
- 1Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Special Administrative Region, Hong Kong, China
- 2Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Special Administrative Region, Hong Kong, China
- 3Department of Medicine, Tseung Kwan O Hospital, Special Administrative Region, Hong Kong, China
- 4Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Special Administrative Region, Hong Kong, China
- 5Department of Medicine and Geriatrics, Princess Margaret Hospital, Kwai Chung, Special Administrative Region, Hong Kong, China
- 6Department of Medicine and Geriatrics, Kwong Wah Hospital, Yau Ma Tei, Special Administrative Region, Hong Kong, China
- 7Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Sha Tin, Special Administrative Region, Hong Kong, China
- 8Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Special Administrative Region, Hong Kong, China
Abstract
Background: 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.
Methods: 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.
Results: 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’.
Conclusions: 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.
Clinical trial number: Not applicable.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12882-026-05244-x.
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BibTeX
@article{ma2026cost,
title = {{Cost utility analysis of two BK polyomavirus screening strategies: quantitative polymerase chain reaction vs 2-stage approach}},
author = {Maggie Kam-Man Ma and Jasper Fuk-Woo Chan and Tsz-Ling Ho and Darwin Chi-Kwan Lam and William Lee and Ho-Kwan Sin and Cheuk-Chun Szeto and Chi-Kwan Wong and Sydney Chi-Wai Tang},
journal = {BMC Nephrology},
year = {2026},
month = aug,
doi = {10.1186/s12882-026-05244-x},
url = {https://doi.org/10.1186/s12882-026-05244-x},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Cost utility analysis of two BK polyomavirus screening strategies: quantitative polymerase chain reaction vs 2-stage approach
AU - Maggie Kam-Man Ma
AU - Jasper Fuk-Woo Chan
AU - Tsz-Ling Ho
AU - Darwin Chi-Kwan Lam
AU - William Lee
AU - Ho-Kwan Sin
AU - Cheuk-Chun Szeto
AU - Chi-Kwan Wong
AU - Sydney Chi-Wai Tang
PY - 2026
DA - 2026/08/10
JO - BMC Nephrology
DO - 10.1186/s12882-026-05244-x
UR - https://doi.org/10.1186/s12882-026-05244-x
AB - Background: 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. Methods: 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. Results: 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’. Conclusions: 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. Clinical trial number: Not applicable. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12882-026-05244-x.
SN - 1471-2369
ER -