Estimating the Burden of Cost in Chronic Graft-versus-Host Disease: A Human Capital Approach

Abstract

With advances in organ matching and preventing acute graft-versus-host-disease (aGvHD), chronic graft-versus-host disease (cGvHD) following allogeneic hematopoietic stem cell transplantation (HSCT) has become a focus of transplant-related morbidity and mortality. Given that cGvHD often presents years following a transplant, our objective was to estimate its burden of cost resulting from allogeneic HSCT based on published estimates of incidence, morbidity, the value of lost work time and survivorship. Our choice of a ten-year time horizon is novel to the field of rare disease and was determined to be meaningful after consultations with present co-authors, including five physicians, one of whom is a transplant surgeon. A total of 44 450 cGvHD patients in the United States were estimated to require treatment over the next decade (from 2015 to 2025). This estimate is based on the last 5 years of trends reported in the transplant registries. What is not reported in any registry is that these patients will accrue a total of 605 631 years of lost wages, a collective lost productivity that will cost society over $27 Billion in the decade ahead: more than five times ($27B vs. $5.2B) the estimated ten-year cost of treating the condition.

Real-world study of direct medical and indirect costs and time spent in healthcare in patients with chronic graft versus host disease

“…Moreover, a longitudinal study in the United States showed that, among patients who had undergone HSCT, only 41% of patients with cGVHD had returned to work by the third year of follow-up compared with 95% of patients without cGVHD [ 16 ]. Similarly, a sensitivity analysis in the United States on the loss of wages and productivity in patients with all cases of cGVHD showed that only 37.5% of these patients would ever return to work [ 28 ]. Of those studied, 75% of patients would be expected to fully recover and only lose 3 years of earnings, the remaining 25% would each lose 20 years of earnings because of permanent disability [ 28 ].…”

“…Similarly, a sensitivity analysis in the United States on the loss of wages and productivity in patients with all cases of cGVHD showed that only 37.5% of these patients would ever return to work [ 28 ]. Of those studied, 75% of patients would be expected to fully recover and only lose 3 years of earnings, the remaining 25% would each lose 20 years of earnings because of permanent disability [ 28 ]. Again, showing similar findings on the impact of work, a recent questionnaire study by the North American cGVHD Consortium (Canada and United States) assessed the insurance, employment, and financial challenges endured by patients with cGVHD who had undergone HSCT [ 29 ].…”

“…Beyond direct health care cost, indirect costs also have a significant contribution to the total cost of illness [27]. Studies published since 2010 have reported that cGVHD burden of illness translates into a higher cost to society and loss of productivity from those patients with cGVHD who are unable to work [16,28,29]. A cost-of-illness analysis in the United States estimated that the financial burden of cGVHD in patients (n = 44,450) would accumulate a total of 605,631 years in lost wages, and a loss of productivity; only 37.5% of patients with cGVHD would return to work [28].…”

“…While studies have examined the considerable economic cost of cGVHD and have shown the association of HSCT with reduced work capacity, there are insufficient data concerning productivity and sickness absence, and resulting economic costs in patients incurred by treating cGVHD following haematological malignancies. Additionally, there is a lack of European data on indirect costs, with the majority of data from North America [16,28,29]. Considering direct healthcare costs in parallel with the indirect cost [27] is important to provide a more integrated insight into the economic burden of cGVHD.…”

“…Studies published since 2010 have reported that cGVHD burden of illness translates into a higher cost to society and loss of productivity from those patients with cGVHD who are unable to work [ 16 , 28 , 29 ]. A cost-of-illness analysis in the United States estimated that the financial burden of cGVHD in patients ( n = 44,450) would accumulate a total of 605,631 years in lost wages, and a loss of productivity; only 37.5% of patients with cGVHD would return to work [ 28 ]. Similarly, in a longitudinal study that evaluated the QoL and number returning to work, 41.0% of patients with cGVHD returned to work compared with 95.0% without cGVHD [ 16 ].…”