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. 2021 Feb;22(1):169-180.
doi: 10.1007/s10198-020-01249-x. Epub 2020 Dec 4.

Real-world study of direct medical and indirect costs and time spent in healthcare in patients with chronic graft versus host disease

Frida Schain  1   2   3 , Nurgul Batyrbekova  4   5 , Johan Liwing  6   7 , Simona Baculea  8 , Thomas Webb  8 , Mats Remberger  9 , Jonas Mattsson  10   11   12
Affiliations

Real-world study of direct medical and indirect costs and time spent in healthcare in patients with chronic graft versus host disease

Frida Schain et al. Eur J Health Econ. 2021 Feb.

Abstract

Chronic graft versus host disease (cGVHD) is a debilitating and costly complication following haemopoietic stem cell transplantation (HSCT). This study describes the economic burden associated with cGVHD. Direct costs associated with specialised healthcare utilisation (inpatient admissions and outpatient visits), as well as indirect costs associated with sickness absence-associated productivity loss were estimated in patients who underwent allogeneic HSCT in Sweden between 2006 and 2015, linking population-based health and economic registers. To capture the period of chronic GVHD, patients were included who survived > 182 days post-HSCT (start of follow-up), and cGVHD was classified based on patient treatment records to correct for any diagnosis underreporting. Patients were classified as 'non-cGVHD' if they received no immunosuppressive treatment, 'mild cGVHD' if they received only systemic corticosteroid treatment or immunosuppressive treatment, or 'moderate-severe cGVHD' if they received extracorporeal photopheresis (ECP) only, corticosteroid treatment and immunosuppressive treatment, or systemic corticosteroid treatment and ECP treatments. Patients with moderate-severe cGVHD spent more time in healthcare, had higher healthcare resource costs and higher sickness absence-related productivity loss compared to patients with non- or mild cGVHD. The cumulative total costs during the first 3 years of follow-up were EUR 14,887,599, EUR 20,544,056, and EUR 47,811,835 for non-, mild, and moderate-severe groups, respectively. The long-term costs incurred with cGVHD following HSCT continue to be very high and significantly impacted by cGVHD severity. This study adds real-world health resource and economic insight relevant for policy-makers and healthcare providers when considering the clinical challenge of balancing immunosuppression to reduce cGVHD.

Keywords: Chronic graft versus host disease; Direct medical costs; Economic burden; Indirect costs; Sweden.

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Conflict of interest statement

Frida Schain is now the owner of and employed by Schain Research AB and acts as a contractor for Janssen; has also been an employee for Janssen; has also previously been a shareholder of Johnson & Johnson stocks; and is affiliated to Karolinska Institutet but receives no payments or salary. Nurgul Batyrbekova is employed by Scandinavian Development Services, who received financial compensation from Janssen-Cilag for conducting statistical analysis. Simona Baculea is employed by Janssen and owns company shares. Johan Liwing is employed by Janssen and owns stocks and options. Thomas Webb was previously employed by Janssen Global Services; reports personal fees from Janssen during the conduct of the study; and is now employed by Eisai Ltd, UK. Mats Remberger and Jonas Mattsson declare they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Direct medical costs and days spent in healthcare for patients with non-, mild and moderate–severe cGVHD, per follow-up year from 182 days post-HSCT. Cumulative direct medical all patient costs (a) and per patient cost (b) by cGVHD severity. Number of days spent in healthcare (inpatient and outpatient) (c). cGVHD chronic graft versus host disease, IQR interquartile range
Fig. 2
Fig. 2
Indirect costs due to sickness absence-associated productivity loss in patients with non-, mild and moderate–severe cGVHD, per follow-up year from 182 days post-HSCT. Sickness absence rates (a), cumulative all patient (b) per patient productivity loss costs by cGVHD severity. cGVHD chronic graft versus host disease, IQR interquartile range
Fig. 3
Fig. 3
Total costs combining direct medical and indirect productivity costs in patients with non-, mild and moderate–severe cGVHD, per follow-up year from 182 days post-HSCT. Cumulative all patient total cost, with proportion of direct medical cost (dark shading) and indirect productivity cost (light shading) (a). Total costs per patient per year (b). cGVHD chronic graft versus host disease, IQR interquartile range, D direct medical cost, I indirect medical cost
See this image and copyright information in PMC

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