Precision Health Economics and Outcomes Research, Boston, MA.
Tufts University School of Medicine, Boston, MA.
Blood Adv. 2022 Mar 8;6(5):1566-1576. doi: 10.1182/bloodadvances.2021004364.
Noninfectious pulmonary complications (NIPC) after allogeneic hematopoietic stem cell transplantation (alloHSCT), including bronchiolitis obliterans syndrome (BOS), cause significant morbidity and mortality, but their impact on health care resource utilization (HRU) and costs is unknown. This longitudinal retrospective study quantified the economic burden of NIPC and BOS in alloHSCT patients using commercial claims data from the IQVIA PharMetrics Plus database. Study patients were aged 0 to 64 years and underwent alloHSCT between 1 January 2006 and 30 September 2018, and were observable 12 months before and up to 5 years after index alloHSCT. NIPC patients were identified using International Classification of Disease (ICD) diagnosis codes. Outcomes were mean per patient HRU (inpatient admissions, outpatient office, hospital visits, and prescription medications) and costs paid by insurers in each post-transplant year. Among 2162 alloHSCT patients, 254 developed NIPCs, and 155 were propensity score (PS)-matched to non-NIPC patients. The year following transplantation, NIPC patients had significantly higher inpatient admission rates (3.8 ± 3.2 vs non-NIPC: 2.6 ± 2.4; P < .001) and higher total costs ($567 870 vs $412 400; P = .07), reflecting higher costs for inpatient admissions ($452 475 vs $300 202; P = .06). Among those observable for more years, costs remained higher for NIPC patients, reflecting significantly higher inpatient admission rates in the first 3 years following transplant. Subanalysis of patients with diagnoses likely reflective of BOS were consistent with these findings. AlloHSCT patients who developed NIPC had higher health care resource utilization and incurred higher costs compared with alloHSCT patients who did not develop NIPC following transplant.
异基因造血干细胞移植（alloHSCT）后的非传染性肺部并发症（NIPC），包括闭塞性细支气管炎综合征（BOS），会导致严重的发病率和死亡率，但它们对医疗资源利用（HRU）和成本的影响尚不清楚。本纵向回顾性研究使用 IQVIA PharMetrics Plus 数据库中的商业索赔数据，量化了 alloHSCT 患者中 NIPC 和 BOS 的经济负担。研究患者年龄在 0 至 64 岁之间，于 2006 年 1 月 1 日至 2018 年 9 月 30 日期间接受 alloHSCT，并在指数 alloHSCT 前 12 个月至 5 年后可观察。使用国际疾病分类（ICD）诊断代码识别 NIPC 患者。结果是每个移植后年份每个患者的平均医疗资源利用（住院入院、门诊、医院就诊和处方药物）和保险公司支付的费用。在 2162 名 alloHSCT 患者中，有 254 名患者发生了 NIPC，其中 155 名患者与非 NIPC 患者进行了倾向评分（PS）匹配。移植后第一年，NIPC 患者的住院入院率（3.8±3.2 比非 NIPC：2.6±2.4；P<0.001）和总费用（567870 美元比 412400 美元；P=0.07）均显著较高，反映出住院入院费用（452475 美元比 300202 美元；P=0.06）较高。在可观察到更多年份的患者中，NIPC 患者的成本仍然较高，反映出移植后前 3 年住院入院率显著较高。对可能反映 BOS 诊断的患者进行的亚分析结果与这些发现一致。与移植后未发生 NIPC 的 alloHSCT 患者相比，发生 NIPC 的 alloHSCT 患者的医疗资源利用率更高，且成本更高。
