Healthcare resource utilization and costs among patients with steroid-resistant chronic graft-versus-host disease in the United States: a retrospective claims database analysis

Abstract

Background

Chronic graft-versus-host disease (cGVHD) is the most serious non-relapse complication affecting long-term allogeneic hematopoietic cell transplantation (HCT) survivors. We describe healthcare resource utilization (HCRU) and costs in patients with steroid-resistant (SR) cGVHD versus no GVHD up to 360 and 720 days post-HCT.

Methods

Claims from the Optum Research Database were used to identify patients aged ≥12 years who underwent allogeneic HCT (index date) in the United States from 01 January 2010 to 31 August 2016 with diagnosis of cGVHD (within the study period or unspecified GVHD beyond 120 days post-HCT [SR defined as additional therapy ≥7 days after initiation of systemic steroids]) or no GVHD at any time. All-cause HCRU and costs were compared in patients with SR cGVHD (1-year analysis, n = 296; 2-year analysis, n = 178) versus no GVHD (1-year analysis, n = 227; 2-year analysis, n = 158).

Results

Most patients with SR cGVHD (75%) received ≥4 lines of therapy during follow-up. Patients with SR cGVHD had significantly more median office visits (49 vs. 27), outpatient visits (69 vs. 24), emergency department visits (1 vs. 0), and inpatient admissions (2 vs. 1) within 1 year post-HCT versus patients with no GVHD (all p<.001); HCRU was also higher in the 2-year period. Median total all-cause costs were significantly higher (p<.001) for patients with SR cGVHD versus no GVHD in the 1-year ($372,254 vs. $219,593) and 2-year ($532,673 vs. $252,909) follow-up periods.

Conclusions

Patients with SR cGVHD required multiple lines of therapy and used significantly more outpatient and inpatient resources resulting in higher costs versus patients with no GVHD.

Keywords:

• Chronic GVHD
• claims database
• healthcare resource utilization
• hematopoietic cell transplantation
• steroid resistant

Transparency

Declaration of funding

The study was funded by Incyte Corporation.

Declaration of financial/other relationships

JY and SP are employees and shareholders of Incyte Corporation. LSL is an employee of Optum, Inc. AA and MD are employees and shareholders of Optum, Inc. (UnitedHealth Group). DW has received research support from Incyte Corporation and support as a consultant from Pharmacyclics and FATE. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

JY, LSL, AA, and MD participated in research design, in the performance of the research, and in data analysis. SP participated in research design and in the performance of the research. DW participated in research design. All authors contributed to manuscript writing, approved the final version for submission, and agree to be accountable for all aspects of the work.

Acknowledgements

Medical writing assistance was provided by Tania Iqbal, PhD, an employee of ICON (North Wales, PA) and was funded by Incyte Corporation (Wilmington, DE).