Healthcare Costs Of Patients With Acute And Chronic Graft-Versus-Host Disease Following Allogeneic Haematopoietic Stem Cell Transplantation In Belgium: A Retrospective Data Collection And Analysis

Abstract

Graft-versus-host disease (GvHD) presents a major challenge to successful allogeneic stem cell transplantation (aSCT). Extracorporeal photopheresis (ECP) is a promising alternative to standard immunosuppressive therapies but it was not available at the participating study centre in Belgium. A retrospective analysis was undertaken of resource use and treatment costs with available therapies in patients who developed steroid-refractory or steroid-dependent acute (aGvHD) or chronic GvHD (cGvHD) following aSCT. Data were collected on number, duration and cost of hospitalisations, GvHD-related diagnostic procedures, and treatment for the management of symptoms and complications of GvHD. A hypothetical date was identified (the index date; ID) at which clinicians would have referred patients to ECP had it been available. Costs were analysed prior to the potential referral for ECP and compared with those after referral. The study group comprised 26 patients with aGvHD (n=17) or cGvHD (n=9), all eligible for ECP treatment had it been available. The costs of GvHD management at the centre were primarily driven by high inpatient hospitalisation costs. Average monthly inpatient cost was €2,687 per patient prior to the ID and €2,689 between the ID and the end of the study. Average monthly outpatient cost was €753 per patient prior to the ID and €542 between the ID and end of the analysis. This analysis, undertaken in a small number of patients, suggests that the management of patients with GvHD following aSCT is associated with high healthcare burden in Belgium, primarily related to hospitalisations. A significant unmet need remains for effective GvHD therapies and options such as ECP should be considered. Accessibility to ECP is limited in Belgium and not reimbursed. A similar retrospective analysis is planned to confirm potential changes in healthcare utilisation and costs with ECP treatment.