PSY124 - COST OF ALLOGENEIC HSCT COMPLICATIONS IN BRAZIL: A DETERMINISTIC LINKAGE APPROACH FOCUSING ON PATIENTS WITH GVHD

Abstract

To explore a population-based cohort of patients with graft-versus host disease (GVHD) in Brazil, by describing clinical characteristics, costs and its potential use for decision-making. A population-based cohort study of 2.877 GVHD patients (2008 - 2016) were identified through a deterministic linkage between two large database in Brazil that represents hospitals and ambulatory (outpatient setting) dispensed medications. The code T86.0 (International Classification of Diseases v.10) was used to initially select patients with GVHD. After data cleaning process, the unique key identifier code was generated by the deterministic match between city, year, month of hospital discharge and dispensation, sex, and birth date. The sample was composed by females (60%), with an average of 31±17 years old. Most of the patients stayed in the hospital at least for 13±10 days and the cost related for GVHD complications was BRL 82.822±44.088. Among the medications used to treat GVHD, most patients were on tacrolimus (42%), mycophenolate mofetil (27%), cyclosporine (21%), sirolimus (10%) and everolimus (0.5%). Although the database has few limitations, valuable insights can be made based on these results. Since the cost of GVHD complications after allogeneic hematopoietic transplantation is high, technologies with the potential to reduce the economic burden of GVHD complication here described may be of interest of decision-makers. For instance, useful comparators for future economic evaluations and population-based cohorts should take into account cyclosporine, tacrolimus, mycophenolate mofetil and sirolimus; whereas everolimus was the least used drug therapy. It is possible that tacrolimus, mycophenolate and sirolimus were the options for refractory chronic GVHD, since first line in Brazil is currently treated with cyclosporine and steroids. This information suggests that the database has potential to be used to improve GVHD care in Brazil, by using real world data in economic models and future population-based observational studies.