Burden of Cost in Chronic Graft Versus Host Disease Following Hematopoietic Stem Cell Transplantation: Predictions for the Next Decade

Jonesn, CA; Fernandez, Luca; Mesa, OA; Weimersheimer, Peter; Peters, Christian

doi:10.1016/j.jval.2015.09.382

Cited by 4 publications

(3 citation statements)

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“…Another difference is the cost of the reviewed treatments. In another study Jones et al [20] evaluated the cost burden of cGVHD by the summation of direct and indirect costs from prior studies. They estimated the total 10-year cGVHD cost burden as US$30.2 billion [20].…”

Section: Discussionmentioning

confidence: 99%

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Steroid Refractory Chronic Graft-Versus-Host Disease: Cost-Effectiveness Analysis

Yalniz

Murad

Lee

et al. 2018

Biology of Blood and Marrow Transplantation

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Given the increasing incidence of chronic graft-versus-host disease (cGVHD) and its rapidly escalating costs due to many lines of drug treatments, we aimed to perform a meta-analysis to assess the comparative effectiveness of various treatment options. Using these results, we then conducted a cost-effectiveness analysis for the frequently utilized agents in steroid-refractory cGVHD. We searched for studies examining tacrolimus, sirolimus, rituximab, ruxolitinib, hydroxychloroquine, imatinib, bortezomib, ibrutinib, extracorporeal photopheresis, pomalidomide, and methotrexate. Studies with a median follow-up period shorter than 6 months and enrolling fewer than 5 patients were excluded. Meta-analysis for overall and organ system-specific GVHD response (overall response [ORR], complete response [CR], and partial response [PR]) was conducted for each intervention. Cost per CR and cost per CR + PR were calculated as the quotient of the 6-month direct treatment cost by CR and CR + PR. Forty-one studies involving 1047 patients were included. CR rates ranged from 7% to 30% with rituximab and methotrexate, respectively, and ORR ranged from 30% to 85% with tacrolimus and ruxolitinib, respectively. Cost per CR ranged from US$1,187,657 with ruxolitinib to US$680 with methotrexate. Cost per ORR ranged from US$453 for methotrexate to US$242,236 for ibrutinib. The most cost-effective strategy was methotrexate for all of the organ systems. Pomalidomide was found to be the least cost-effective treatment for eye, gastrointestinal, fascia/joint, skin, and oral GVHD, and imatinib was found to be the least cost-effective treatment for liver and extracorporeal photopheresis for lung GVHD. We observed huge cost-effectiveness differences among available agents. Attention to economic issues when treating cGVHD is important to recommend how treatments should be sequenced, knowing that many patients will cycle through available agents.

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Section: Discussionmentioning

confidence: 99%

“…However, along with several other factors (eg, increase in peripheral blood stem cells for HCT), this improved early survival has also contributed to an increase in the incidence of cGVHD. More than 40,000 cGVHD patients are estimated from the last 5 years of trends reported in the registries to require treatment over the next decade [20].…”

Section: Introductionmentioning

confidence: 99%

Steroid Refractory Chronic Graft-Versus-Host Disease: Cost-Effectiveness Analysis

Yalniz

Murad

Lee

et al. 2018

Biology of Blood and Marrow Transplantation

View full text Add to dashboard Cite

show abstract

“…Furthermore, reported costs represent only a fraction of the total medical costs of cGVHD because they do not include costs of adjunct therapies (eg, a 6-month course of voriconazole or posaconazole alone can incur an additional $9000 or $42,000, respectively), management of end-organ complications occurring with ongoing corticosteroid use (eg, steroidinduced hyperglycemia and overt diabetes occur in 20% to 60% of patients on long-term corticosteroids [10]), or those arising from frequent complications of ongoing and profound immunosuppression (eg, repeat severe infections necessitating hospital admissions). Thus, it is not surprising that estimates pegged the direct medical costs of cGVHD care in the United States over a 10-year period to more than $5,000,000,000 [11]. With the advent of new therapies highlighted in this study, this sum likely underestimates the continuously evolving financial burden of cGVHD on healthcare systems.…”

mentioning

confidence: 91%