Healthcare Resource Utilization (HCRU) and Costs Among Patients with Steroid-Resistant (SR) Chronic Graft-Vs-Host Disease (cGVHD) in the United States: A Retrospective Claims Database Analysis

Introduction cGVHD remains the most serious nonrelapse complication affecting long-term survivors of allogeneic hematopoietic stem cell transplant (allo-HSCT). The therapeutic mainstay for cGVHD is steroids; however, the overall response rate is only approximately 50%. Objective To estimate HCRU and costs associated with SR cGVHD following allo-HSCT in the United States. Method Administrative claims from the Optum Research Database were used to identify allo-HSCT patients from 01/01/10 to 08/31/16. Patients with cGVHD had ≥2 outpatient or ≥1 inpatient claim with cGVHD diagnosis specified as (1) cGVHD (ICD-9 279.52 or ICD-10 d89.811) within study period or (2) unspecified GVHD (ICD-9 279.50 or ICD-10 D89.813) beyond 120 days after HSCT. Patients with SR cGVHD were those treated with additional therapy at least 7 days after initiation of systemic steroids based on outpatient treatment records. The no-GVHD group had no GVHD claim during the follow-up. Patients were included if ≥12 years old, enrolled in commercial or Medicare Advantage plan ≥6 months preceding and ≥360 days post-HSCT (≥720 days for 720-day analysis) while surviving. All-cause HCRU and costs (uninflated amount in US dollars) during 360 and 720 days post-HSCT were compared between patients with SR cGVHD and no GVHD using chi-square test for categorical variables and nonparametric test for costs. Result 296 (178) patients with SR cGVHD and 227 (158) patients with no GVHD were included in the 360-day (720-day) analysis. Mean age (50 vs 49 years) and female (40% vs 41%) were similar in patients with SR cGVHD and no GVHD (P>0.05). The primary diagnoses for HSCT were acute myeloid leukemia (42% vs 36% in patients with SR cGVHD and no GVHD), non-Hodgkin lymphoma (13% vs 15%), and acute lymphoblastic leukemia (12% vs 10%). Median time from cGVHD diagnosis to initiation of second-line therapy was 60 days (interquartile range [IQR]: 33–121). 75% of patients with SR cGVHD used ≥4 lines of therapy over the period of follow-up. SR cGVHD patients had significantly more office visits, outpatient consultations, emergency room visits, and inpatient admissions within both 360 and 720 days post-HSCT than patients with no GVHD (all P Figure 1 ). Median total 360- and 720-day post-HSCT all-cause costs and components of costs were all higher for patients with SR cGVHD vs those without GVHD (P Figure 2 ). Conclusion Most patients with SR cGVHD received multiple lines of therapy and additionally used significantly more outpatient and inpatient resource through 2 years post-HSCT than those without GVHD. Improved prevention as well as early and effective treatment of cGVHD may substantially reduce their costs of care.