a Incyte Corporation, US Medical Affairs , Wilmington , DE , USA.
b Evidera Inc. , Modeling and Simulation , Waltham , MA , USA.
Curr Med Res Opin. 2019 Jun;35(6):983-988. doi: 10.1080/03007995.2018.1551193. Epub 2018 Dec 20.
Acute graft-versus-host disease (aGVHD) is a common and life-threatening complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). The extent to which aGVHD increases inpatient costs associated with allo-HSCT has not been thoroughly evaluated. In this analysis, mortality, hospital length of stay (LOS) and costs associated with aGVHD during allo-HSCT admissions are evaluated.
This is a retrospective analysis of discharge records from the National Inpatient Sample database for patients receiving allo-HSCT between 1 January 2009 and 31 December 2013. Allo-HSCT discharges with an aGVHD diagnosis were included in the aGVHD group and those without any graft-versus-host disease (GVHD) diagnosis comprised the non-GVHD group. Mortality, LOS and costs were compared between the two groups, as well as within subgroups, including age (<18 vs. ≥18 years) and survival status (alive vs. deceased) at discharge.
Overall, mortality (16.2% vs. 5.3%; p < .01), median hospital LOS (42.0 vs. 26.0 days; p < .01) and median total costs ($173,144 vs. $98,982; p < .01) were significantly increased in patients with aGVHD versus those without GVHD during hospitalizations for allo-HSCT, irrespective of age group. Patients with aGVHD who were <18 years of age had a lower mortality rate but greater hospital LOS and total costs versus patients aged ≥18 years. Patients who died during allo-HSCT hospitalization had longer LOS and incurred greater costs than those who survived in both the aGVHD and non-GVHD groups.
Occurrence of aGVHD during allo-HSCT admissions resulted in a tripling of the mortality rate and a near doubling of hospital LOS and total costs. In addition, death during allo-HSCT hospitalizations was associated with greater healthcare utilization and costs. Effectively mitigating aGVHD may improve survival and substantially reduce hospital LOS and costs for allo-HSCT.
急性移植物抗宿主病(aGVHD)是异基因造血干细胞移植(allo-HSCT)的常见且危及生命的并发症。尚未彻底评估 aGVHD 增加 allo-HSCT 相关住院费用的程度。在这项分析中,评估了 allo-HSCT 住院期间与 aGVHD 相关的死亡率、住院时间(LOS)和费用。
这是对 2009 年 1 月 1 日至 2013 年 12 月 31 日期间接受 allo-HSCT 的国家住院患者样本数据库的出院记录进行的回顾性分析。将有 aGVHD 诊断的 allo-HSCT 出院患者纳入 aGVHD 组,而没有任何移植物抗宿主病(GVHD)诊断的患者纳入非 GVHD 组。比较两组之间以及亚组(出院时年龄<18 岁与≥18 岁和存活状态)之间的死亡率、LOS 和费用。
总体而言,死亡率(16.2% vs. 5.3%;p<.01)、中位住院 LOS(42.0 与 26.0 天;p<.01)和中位总费用($173,144 与 $98,982;p<.01)在 allo-HSCT 住院期间患有 aGVHD 的患者中明显高于无 GVHD 的患者,无论年龄组如何。年龄<18 岁的 aGVHD 患者死亡率较低,但 LOS 和总费用均高于≥18 岁的患者。allo-HSCT 住院期间死亡的患者与存活患者相比,LOS 更长,费用更高,无论在 aGVHD 组还是非 GVHD 组均如此。
allo-HSCT 住院期间发生 aGVHD 导致死亡率增加两倍,住院 LOS 和总费用增加近一倍。此外,allo-HSCT 住院期间死亡与更高的医疗保健利用率和费用相关。有效减轻 aGVHD 可能会提高生存率,并显著降低 allo-HSCT 的住院 LOS 和费用。