Economic Burden of Cytomegalovirus infection in CMV-Seropositive Hematopoietic Stem Cell Transplant Recipients Managed with Pre-Emptive Therapy: A Single Center Experience

Abstract

<h3>Introduction</h3> <i>Cytomegalovirus</i> (CMV) infection is a common viral infection in allogeneic hematopoietic stem cell transplantation (HCT) recipients, especially in the first 100 days post HCT. Preemptive therapy (PET) proved to be effective in managing CMV but led to prolonged antiviral use and associated toxicities. Limited data exist on the economic burden of PET use and cost of care among HCT recipients. <h3>Objectives</h3> We aimed to compare direct all-cause or CMV-related inpatient healthcare resource use and costs in those who received or did not receive PET through 180 days (D180) post HCT. <h3>Methods</h3> Study cohort comprised of adults, CMV R+ allogeneic HCT recipients of first peripheral blood or marrow allograft at a single center from 3/2013 to 12/2017. HCT recipients were routinely monitored for CMV using quantitative PCR assay and administered PET as per the standards of care. Data on clinical characteristics, CMV outcomes, PET administration, reasons and dates of hospitalizations were extracted from the electronic medical records. Inpatient hospital charges were obtained from the Vizient billing database from date of HCT to D180 post HCT. Charges data were converted to costs using cost-to-charge ratios, wage index and inflation rate to 2017 US Dollars. CMV-related readmissions were identified as readmissions for initiation of PET, work up or management of CMV End Organ Disease and any readmission where PET was initiated during D180 post HCT. <h3>Results</h3> Of 368 HCT recipients, 176 (48%) received unmodified graft from matched related or unrelated donors (low CMV risk); and 192 (52%) received either ex vivo T-cell depleted or conventional graft from mismatched donors (high CMV risk). Overall, 208 (57%) HCT recipients received PET; and 72% of them were high risk. PET recipients had longer length of stay for index admission (p=0.0001) and a greater proportion required readmission at D180 (p=0.00005) (Table 1); greater average inpatient costs for index admission ($184,230 vs. $150,938, p=0.0304) and for readmissions through D180 ($105,676 vs. $51,444, p=0.0032) (Table 1) as compared to those who did not receive PET. PET recipients also had higher costs for CMV-related readmissions per episode than non CMV-related readmissions ($167,701 vs. $96,941, p=0.0089) (Table 1). CMV-related readmissions comprised of 37% of total all-cause readmissions and incurred 49% of total all-cause readmission costs in PET recipients (Figure 2). <h3>Conclusion</h3> PET recipients had higher overall inpatient resource use and costs as compared to those who did not receive PET. CMV-related readmissions had disproportionate share of total inpatient readmissions costs in PET recipients. Future studies are needed to examine the cost-effectiveness of alternative strategies for CMV management.