Department I of Internal Medicine, Medical Faculty and University Hospital of Cologne, University of Cologne, Cologne, Germany.
Certara France, Paris, France.
Transplant Proc. 2024 Jan-Feb;56(1):191-200. doi: 10.1016/j.transproceed.2023.11.032. Epub 2024 Jan 10.
Acute graft-vs-host disease (aGVHD) is a serious complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT), yet there are limited data on the clinical and economic burden of aGVHD in Germany. This real-world study aimed to evaluate clinical and economic outcomes among patients in Germany with or without aGVHD after allo-HSCT.
This retrospective cohort study used administrative claims extracted from the German statutory health insurance database. Eligible adult patients underwent allo-HSCT between 1 January 2009 and 31 December 2017 for any hematological malignancy. Clinical (severe infections and mortality) and economic (health care resource use [HCRU] and costs) outcomes were compared in "aGVHD" patients and "no GVHD" patients. Propensity score matching (1:1) was used to balance covariates between the aGVHD and no GVHD groups.
After propensity score matching, 95 aGVHD and 95 no GVHD patients were included in the analysis. The aGVHD group had significantly higher odds of mortality than the no GVHD group (odds ratio [OR] 2.2; 95% CI 1.2-4.0). Odds of severe infection were similar between the 2 groups (OR 1.7; 95% CI 0.9-3.3). Patients in the aGVHD group had significantly more overnight hospitalizations per patient-year (mean [SD]: 3.7 [3.0] and 2.7 [2.5], P = .029), and total direct costs were 1.6-fold higher than those in the no GVHD group.
Among patients who underwent allo-HSCT, aGVHD was associated with significantly higher mortality, HCRU, and costs, highlighting the need for effective prophylaxis and treatment options to prevent or reduce the incidence of aGVHD.
急性移植物抗宿主病（aGVHD）是异基因造血干细胞移植（allo-HSCT）的严重并发症，但德国关于 aGVHD 的临床和经济负担的数据有限。本真实世界研究旨在评估德国 allo-HSCT 后伴或不伴 aGVHD 的患者的临床和经济结局。
这是一项回顾性队列研究，使用从德国法定健康保险数据库中提取的管理索赔数据。符合条件的成年患者于 2009 年 1 月 1 日至 2017 年 12 月 31 日期间因任何血液系统恶性肿瘤接受 allo-HSCT。比较“aGVHD”患者和“无 GVHD”患者的临床（严重感染和死亡率）和经济（医疗资源使用[HCRU]和成本）结局。采用倾向评分匹配（1:1）平衡 aGVHD 组和无 GVHD 组之间的协变量。
经倾向评分匹配后，共有 95 例 aGVHD 和 95 例无 GVHD 患者纳入分析。aGVHD 组的死亡率明显高于无 GVHD 组（比值比[OR] 2.2；95%置信区间[CI] 1.2-4.0）。两组严重感染的可能性相似（OR 1.7；95%CI 0.9-3.3）。aGVHD 组每位患者每年的夜间住院次数明显更多（平均值[标准差]：3.7[3.0]和 2.7[2.5]，P=0.029），总直接成本也比无 GVHD 组高 1.6 倍。
在接受 allo-HSCT 的患者中，aGVHD 与死亡率显著升高、HCRU 和成本显著增加相关，这突显了需要有效的预防和治疗方案来预防或减少 aGVHD 的发生。
