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Healthcare utilization and financial impact of acute-graft-versus host disease among children undergoing allogeneic hematopoietic cell transplantation

Bone Marrow Transplantation volume 55, pages 384–392 (2020)Cite this article

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Abstract

The impact of AGVHD on healthcare utilization and cost is not well described. In this retrospective single center cohort study of 240 pediatric patients, we analyzed cost, healthcare utilization and patient outcomes for the first year post-alloHCT. Costs were estimated from charges recorded in the Pediatric Health Information System database and the hospital’s accounting system. The overall incidence of grade I–IV aGVHD was 40.4%. The incidence of grade I, grade II, and grade III–IV aGVHD was 6.6%, 16.2%, and 17.5%, respectively. The overall incidence of steroid refractory (SR)-aGVHD was 10.8%. The median number of days of hospitalization in the first year post-alloHCT was significantly higher for patients with aGVHD vs. no aGVHD: 113 days (range: 35–354 days) vs. 63 days (range: 25–298 days), p < 0.001. Patients with SR-aGVHD had increased hospitalization compared with the patients with steroid responsive aGVHD (152.8 ± 66.6days vs. 111.3 ± 59.3 days, p = 0.004), with associated increased alloHCT cost of ~$200,000. On multivariable analysis of risk factor for alloHCT cost, aGVHD, was associated with significantly higher cost ($141,094 [SE = 31247], p < 0.001). In summary, aGVHD and SR-aGVHD is associated with prolonged hospitalization and 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.

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Acknowledgements

We would also like to thank Stephanie Kjelleren Conner, MHSA, and Fisnik Prishtina for providing outpatient financial data.

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Authors and Affiliations

  1. Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Department of Pediatrics, Columbia University Medical Center, New York, NY, USA

    Angela Ricci, Larisa Broglie, Monica Bhatia, Diane George, James H. Garvin & Prakash Satwani

  2. Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA

    Zhezhen Jin

  3. Children’s Hospital Association, Lenexa, KS, USA

    Matthew Hall

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  1. Angela Ricci
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Correspondence to Prakash Satwani.

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Ricci, A., Jin, Z., Broglie, L. et al. Healthcare utilization and financial impact of acute-graft-versus host disease among children undergoing allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 55, 384–392 (2020). https://doi.org/10.1038/s41409-019-0688-9

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