Graft-versus-host disease (GVHD) remains a common complication of hematopoietic stem-cell transplant, but little is known about the rate of hospital admissions and the associated costs. Fiona L. Dignan, MD, of the Royal Marsden Hospital, United Kingdom, presented a study comparing readmission rates and associated costs between patients with GVHD and controls.
The analysis included all patients undergoing allogeneic stem-cell transplant (two thirds for leukemia) at the hospital between 2006 and 2009, and followed for a median of 3.2 years.
Costs were based on hospitalization charges in 2010 currency. Additional drug or procedural costs were not included.
Of 187 patients receiving transplant, 118 (63%) developed GVHD, 49% of which was grade 4. The only significant difference between patients with and without GVHD was the increased use of alemtuzumab in the non-GVHD group, 71% versus 54%. Of the 118 patients, 38% had biopsy-proven GVHD, 88% required steroid treatment, and 52% were steroid-refractory.
Acute GVHD was present in 44% of patients, chronic GVHD in 19%, and acute and chronic GVHD in 30%. Seven percent developed GVHD after donor lymphocyte infusion.
Costs and Services Increased 2-fold or More in GVHD Patients
Patients developing GVHD had a significantly higher overall hospital readmission rate after transplant, 89% versus 68% for controls, and a higher mean cost of readmission, €32,217 compared with €15,622, Dr Dignan reported.
They also had a significantly higher mean total number of readmission days, 42 versus 18, and a higher admission rate to the critical care unit, 34% versus 12%.
For patients with grade 3/4 GVHD, compared with grade 1/2, differences were also apparent. More severe patients had a higher mean total number of readmission days, 57 versus 37 (P = .054), and a numerically higher readmission rate, 96% versus 88%. The mean cost of admission for this group was almost double, €44,535 versus €27,001.
“This study shows the high readmission rates and costs associated with the development of GVHD, and highlights the need for new treatment approaches for this condition,” Dr Dignan concluded.
Severe GVHD greatly compromised survival. At 3 years posttransplant, approximately 40% of patients did not develop GVHD, but that proportion dropped to <20% for patients with grade 3/4. Grade 1/2 disease did not diminish survival odds.—CH