Steroid-related complications in GVHD result in substantial costs
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Patients with graft-versus-host disease who developed steroid-related complications required substantial health care resource utilization and incurred considerable costs, according to results presented at TCT Meetings Digital Experience.
The findings of the retrospective cohort study emphasize the need to “cautiously evaluate” treatment options for patients with GVHD, according to Daniel Weisdorf, MD, professor of medicine in the division of hematology, oncology and transplantation at University of Minnesota, and colleagues.
“Clear excess expense was noted, to a large extent tied to extended hospital time for patients with acute and, thus, early post-transplant GVHD,” Weisdorf told Healio. “Extended health care costs follow the development of GVHD. The morbidity, but also the expense, is substantial and needs to be considered [when] assessing the benefits and advantages of alternative prevention and management approaches.”
Steroids often are prescribed to patients with GVHD; however, the prevalence of steroid-associated complications — as well as the costs and health care resource utilization associated with them — has not been established.
“The extended and complex complications of GVHD generate substantial morbidity, extended need for care and associated health care costs,” Weisdorf said. “We wanted to detail — within the limits of claims data — how extensive these expenses and complications were associated with steroid treatment of GVHD.”
Bell and colleagues searched the Optum Research Database to identify U.S. commercial and Medicare Advantage patients with GVHD treated with systemic steroids from July 2010 through August 2019.
Researchers used ICD codes to determine health care resource utilization and costs associated with steroid complications — including those experienced by patients with baseline diagnosis — during the 24-month period after steroid initiation.
The analysis included 689 patients (median age, 55 years; 60% male). Patients used steroids for a median 126 days (range, 52-273).
Nearly all patients (97%) experienced at least one type of complication within 2 years after steroid initiation. Clinically relevant complication types included infection (80%), metabolic/endocrine (32%), gastrointestinal (29%) and bone/muscle (20%).
Mean costs associated with steroid complications were $132,077 (median, $31,565) over 12 months from steroid initiation and $164,786 (median, $50,834) over 24 months from initiation.
The 24-month costs were higher among patients (n = 408) who used steroids for 3 months or longer (mean, $171,434; median, $56,542).
The 24-month costs also were higher among patients with acute GVHD only (mean, $183,944; median, $46,093) than those with chronic GVHD only (mean, $113,199; median, $34,285).
“As captured by these data collection processes, acute — but to a lesser extent, chronic — GVHD has very extensive care needs associated with complications of steroid treatment,” Weisdorf told Healio. “[Although] all costs were not directly attributable to the steroid complications, those with infection, metabolic disorders, GI and bone/joint problems had the greatest increase in health care needs, hospital days and costs.”
The majority of complication-related costs identified occurred in the first year after steroid initiation. This was consistent across complication types (94% for gastrointestinal; 82% for metabolic/endocrine; 80% for infection; 77% for bone/muscle).
Investigators determined hospitalizations were the primary driver of complication-related costs. Hospitalizations accounted for 85.5% ($143,299 of $167,473) of complication-related costs among those who developed infection, 95.7% ($45,077 of $47,101) for those with metabolic/endocrine conditions, 94.4% ($64,077 of $67,861) for those with gastrointestinal conditions and 92.8% ($69,880 of $75,289) for those with bone/muscle conditions.
Additional research is needed to better understand the severity and suspected causes of the complications identified, Bell and colleagues concluded.
“More detail than available from claims data would better dissect the direct and indirect costs associated with steroids as distinct from the needs and expenses that might remain associated with GVHD even if treated with other modalities or agents,” Weisdorf said.
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Bell EJ, et al. Abstract 12. Presented at: The 2021 TCT Meetings Digital Experience (virtual meeting); Feb. 8-12, 2021.
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