The Economic and Health Utilization Cost of Clinically Significant Cytomegalovirus Infection Following Allogeneic Hematopoietic Cell Transplantation

Abstract

Introduction Understanding the economic impact of managing allogeneic hematopoietic stem cell transplant (HCT) recipients with cytomegalovirus (CMV) is important for future planning within institutional transplant programs. CMV remains the most frequent viral infection following HCT but less is known about the impact of CMV on health resource utilization. Objectives We aimed to evaluate the economic burden of CMV infection in a large HCT centre operating under a universal health care system. Methods A retrospective single centre study at the Royal Melbourne Hospital, Australia was performed on all allogeneic HCT recipients between Jan2015 to Dec2017. CMV pre-emptive monitoring using quantitative CMV viral load was performed from time of transplant to 100 days or longer if GVHD. Clinically significant CMV (csCMV) was defined as viremia requiring anti-CMV treatment. First line anti-CMV therapy was (val)ganciclovir and second-line therapy was foscarnet. Hospital costing data for all admissions in the first 12 months were obtained. Financial year costing was available for FY2015/2016 to FY2017/2018. Ethics was approved by the Melbourne Health Human Ethics Review Committee (HREC 2017.368). Results A total of 255 patients underwent alloHCT with a median age of 51 years (IQR 40-59). The most common underlying diagnosis was AML (41%) and 54% had unrelated donor transplants. Pre-transplant recipient CMV seropositivity was 62% (n=158), of whom 139 had detectable CMV viremia and 105 (41.2%) experienced clinically significant CMV (csCMV). The median duration of CMV treatment was 33 days (IQR 21-63). Re-admission to hospital within the first 12 months of HCT occurred in 78.4%. There was a greater number of admissions observed in csCMV patients compared to no csCMV (median 3 vs 2, p=0.001) with the duration of admitted days within the first 12 months being significantly greater in csCMV patients compared to no csCMV (median 65 vs 36 days, p Conclusion The health care cost and resource utilization of treating CMV infection following an allogeneic HSCT is substantial and places a heavy burden on limited health resources. In this study, patients experiencing csCMV had an increased number and longer total duration of admissions days compared to patients who did not require CMV treatment. Interventions aimed at reducing the burden of CMV in alloHCT recipients are required.