Lower Gastrointestinal, Not Upper GI Graft-Versus-Host Disease Increases Healthcare Utilization and Economic Burden for Patients – Hematology Advisor

Allogeneic hematopoietic stem cell transplantation (HSCT) is considered a potentially curative procedure for multiple hematologic diseases, and as such, its use has increased steadily during the previous 2 decades. Acute graft-vs-host disease (aGVHD) after HSCT has been associated with poorer clinical outcomes and mortality.1-3

Acute Graft-vs-Host Disease Overview

aGVHD can cause significant immune dysregulation and organ deterioration due to attack by the donor T cells on the host skin, gastrointestinal tract, and liver tissues.4 Severity of aGVHD progresses from stage I (skin rash, nausea/vomiting) to stage IV (bullae/desquamation, excess bilirubin, and severe diarrhea).5

Risk for aGVHD is associated with increasing age of donor and host, gender mismatch, and HLA disparity. Prophylactic strategies to prevent aGVHD generally involve depletion of T cells by calcineurin inhibitors in combination with methotrexate, mycophenolate mofetil, or sirolimus.5 Upon diagnosis of aGVHD, corticosteroids are widely used as the front-line therapy.5,6

The risk for aGVHD remains high (about 50%)2,3 and has been associated with a mortality rate of about 20%.6 Increased mortality is primarily associated with cases that have involvement of gastrointestinal tissues and/or rapid onset within the first 2 weeks.5

Healthcare Burden of Acute Graft-vs-Host Disease

HSCT was considered in 2009 by the Agency for Healthcare Research and Quality to be among the 10 most costly medical procedures.7 Despite this established fact, the monetary cost of specific aGVHD staging and organ involvement remains poorly understood.1

It is important for physicians to understand the healthcare utilization because there are diseases, like aGVHD, which have a very high burden on our healthcare system, Nosha Farhadfar, MD, Assistant Professor of Medicine in the Division of Hematology and Oncology at University of Florida College of Medicine told Hematology Advisor. We need to be able to not only better control the outcome of these diseases, but also increase the healthcare utilization such that these treatments become more accessible.

Methods

In order to elucidate which aspects of aGVHD cause the greatest burden on healthcare utilization, Dr. Farhadfar and her colleagues assessed electronic medical records from 290 patients undergoing HSCT at their center in 2018. Length of hospitalizations, clinical outcomes, and hospital charges were analyzed on the basis of aGVHD status. They presented the results of this study1 during the Transplantation and Cellular Therapy Meetings of ASTCT and CIBMTR Digital Experience, held remotely February 8-12, 2021.

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Lower Gastrointestinal, Not Upper GI Graft-Versus-Host Disease Increases Healthcare Utilization and Economic Burden for Patients - Hematology Advisor