Severity of Acute GVHD and Associated Healthcare Resource Utilization, Cost and Outcomes.

Abstract

INTRODUCTION\nAcute GVHD (aGVHD) contributes to poor outcomes and increased healthcare resource utilization (HRU) after allogeneic stem cell transplantation (HCT). However,\xa0HRU and the economic burden of aGVHD based on severity of the disease is not well characterized.\n\n\nMETHODS\nStudy cohort included 290\xa0adult HCT recipients between 2010 and 2018.\xa0 Costs, HRU and all-cause mortality among patients with aGVHD and no GVHD were compared during the 100-day and 365-day periods after HCT. The impact of severity of aGVHD and gastrointestinal (GI) involvement on mortality, HRU and economic burden was also evaluated. Medical costs and total hospital days were retrieved from administrative data that allocate costs to services based on departmental input for resource use and were adjusted to 2018 dollars. Wilcoxon rank sum test was used to compare number of inpatient days and total cost. Multivariable linear regression was fitted on log transformed cost.\n\n\nRESULTS\nPatients with aGVHD had significantly more median number of hospital days (28 vs 22), ICU admission rates (13% vs 6%), and re-hospitalization (59% vs 38%) than patients with no GVHD during the first 100 days of HCT. Compared to the no aGVHD group, grade I-II aGVHD significantly prolonged hospital days by a median of 3 days and increased readmission rates by 18%. Severe (grade III-IV) aGVHD resulted in a nearly 30% increase in the readmission rate, doubling of inpatient days, ICU admission rate and mortality during the 100 days following HCT. Lower\xa0GI involvement in aGVHD was also associated with increased risk of re-admission (30%) and twice as many inpatient days, doubling the likelihood of ICU need and mortality over the first 100 days, compared with absence of aGVHD. Similar findings were observed over days 101 to 365 following HCT. The mean attributable aGVHD cost regardless of grade was $60,923 in the first 100 days after HCT. This cost varies by grade. The mean aGVHD attributable costs were $18,071 for grade I, $36,115 for grade II and $120,929 for grades III/IV and $114,668 for aGVHD involving lower GI tract. In the 101-365-day period, the mean attributable aGVHD cost regardless of grade was $17,527. This cost varies by grade. There were no additional aGVHD attributable costs for grade I but the mean aGVHD attributable cost was $9,743 for grade II, $62,220 for grade III/IV aGVHD and $55,724 for aGVHD with lower GI involvement compared to the controls without aGVHD.\n\n\nCONCLUSION\nHigh grade aGVHD and GI involvement in aGVHD, especially lower GI aGVHD, is associated with a considerably increased mortality and healthcare economic burden.\xa0Therefore, it is imperative that new therapeutic strategies are developed for this patient population.