Health Care Utilization and Financial Impact of Acute Graft-Versus-Host Disease (aGVHD) Among Children Undergoing Allogeneic Hematopoietic Cell Transplantation (alloHCT)

Abstract

Introduction Steroids are the only effective treatment for acute GVHD and optimal salvage regimen for steroid refractory (SR) GVHD remains elusive. Impact of steroid sensitive (SS) and SR-AGVHD on healthcare utilization and cost is not well described. Methods In this is a single center study, we analyzed data on of 97/240 (40%) consecutive pediatric patients who developed grade I-IV AGVHD. Among patients with AGVHD, we analyzed cost, healthcare utilization and patient outcomes for the first year post-alloHCT. Costs were estimated from charges recorded in the PHIS database and hospital accounting. SR-AGVHD was defined as failure to respond to steroid treatment. Failure to respond was defined as any Grade II-IV AGVHD that showed progression within 3 days or had no improvement within 7 consecutive days of treatment with 2 mg/kg/day methylprednisolone or equivalent. Results The median age of children with SS-AGVHD vs. SR-AGVHD was 9.44 years (0.26-21.0) vs. 12.2 years (0.42-21.0), p=0.204. The incidence of SR-AGVHD was 27%. Median time to onset of AGVHD was 28 days (6-232). AGVHD was grade III at diagnosis in 71% patients with SR-AGVHD vs. 29% patients with SS-AGVHD, P In multivariable analysis, patients with aGVHD had an average of 45.4 days (p 1-year OS for SR-AGVHD compared to SS-AGVHD was 50% (SE=9.81%) vs. 69.0% (SE=5.49%), p=0.046. Conclusion SR-AGVHD is associated with prolonged hospitalization, higher cost and inferior survival among children. Better AGVHD prevention strategies are desperately needed. Despite significant advances, lack of effective salvage regimens for SR-AGVHD remains a major concern.