دورية أكاديمية
Healthcare Resource Utilization and Costs of Steroid-Associated Complications in Patients With Graft-Versus-Host Disease.
| العنوان: | Healthcare Resource Utilization and Costs of Steroid-Associated Complications in Patients With Graft-Versus-Host Disease. |
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| المؤلفون: | Bell EJ; Optum, Inc., Eden Prairie, Minnesota. Electronic address: elizabeth.bell@optum.com., Yu J; Incyte Corporation, Wilmington, Delaware., Bhatt V; Incyte Corporation, Wilmington, Delaware., Bunner SH; Optum, Inc., Eden Prairie, Minnesota., Lal LS; Optum, Inc., Eden Prairie, Minnesota., Galvin J; Incyte Corporation, Wilmington, Delaware., Weisdorf D; University of Minnesota, Minneapolis, Minnesota. |
| المصدر: | Transplantation and cellular therapy [Transplant Cell Ther] 2022 Oct; Vol. 28 (10), pp. 707.e1-707.e7. Date of Electronic Publication: 2022 Apr 26. |
| نوع المنشور: | Journal Article; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Inc Country of Publication: United States NLM ID: 101774629 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2666-6367 (Electronic) Linking ISSN: 26666367 NLM ISO Abbreviation: Transplant Cell Ther Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: [New York] : Elsevier Inc., [2021]- |
| مواضيع طبية MeSH: | Graft vs Host Disease*/drug therapy , Hematopoietic Stem Cell Transplantation*/adverse effects, Humans ; Male ; Middle Aged ; Patient Acceptance of Health Care ; Retrospective Studies ; Steroids |
| مستخلص: | Acute and chronic graft-versus-host disease (aGVHD/cGVHD) are serious conditions occurring after allogeneic hematopoietic cell transplantation (HCT). Steroids are the most common first-line therapy; however, they are frequently associated with numerous morbid complications. To describe the healthcare resource utilization (HCRU) and costs of steroid-related complications in patients receiving systemic steroids for GVHD. This retrospective study used medical and pharmacy claims from the Optum Research database. Eligible patients were diagnosed with GVHD (aGVHD, cGVHD, or both) after HCT and were treated with systemic steroids between July 1, 2010, and August 31, 2019. The index date was the date of the first claim for systemic steroids after GVHD diagnosis. The baseline period was the 6 months before the index date, and the follow-up period was 2 years after the index date. Outcome variables included HCRU and costs associated with steroid complications, grouped into 4 categories: bone/muscle, gastrointestinal, infection, and metabolic/endocrine. A multivariate analysis was used to assess the cost ratio associated with the presence of each steroid complication; the linear model was adjusted for baseline patient characteristics and types of steroid conditions identified during follow-up. Another multivariate analysis assessed the hazard ratio for hospitalization associated with each steroid complication using a Cox proportional hazards regression model adjusted for the time-varying presence of each complication category. A total of 689 patients were studied (median age, 55 years; male, 60%); 22% had aGVHD only, 21% had cGVHD only, and 39% had both types of GVHD. After 2 years of follow-up, 97% had at least 1 steroid-associated complication. The most common complication category was infection (79.5%), followed by metabolic/endocrine (32.4%), gastrointestinal (29.2%), and bone/muscle conditions (19.7%). About two thirds (66%) of patients with any steroid complication had ≥1 hospitalization requiring a median (interquartile range [IQR]) of 20 (8-43) hospital days. Patients with an infection experienced the highest hospitalization rate (72%) and thus the highest associated costs. The total mean (median [IQR]) healthcare cost potentially related to steroid complications was $164,787 ($50,834 [$8865-$182,693]), and the largest expense was hospitalization (mean [median {IQR}], $140,637 [$26,782 {$0-$141,398}]). Of the different steroid complications, infections were associated with the highest cost (mean [median {IQR}], $167,473 [$57,680 {$16,261-$178,698}]). In addition, a significantly higher total adjusted cost was associated with the presence of an infection, gastrointestinal complication, or bone/muscle complication in patients with GVHD versus the absence of each complication (all P < .001). Complications occurring after steroid treatment for GVHD may add substantially to the HCRU and costs associated with GVHD management. Infections in particular required inpatient care and were associated with the highest economic burden. (Copyright © 2022. Published by Elsevier Inc.) |
| فهرسة مساهمة: | Keywords: Complications; Corticosteroids; Graft-versus-host disease; Healthcare costs; Hematopoietic cell transplantation |
| المشرفين على المادة: | 0 (Steroids) |
| تواريخ الأحداث: | Date Created: 20220428 Date Completed: 20221010 Latest Revision: 20221025 |
| رمز التحديث: | 20240628 |
| DOI: | 10.1016/j.jtct.2022.04.014 |
| PMID: | 35483620 |
| قاعدة البيانات: | MEDLINE |
Full Text via ClinicalKey 
Full Text Finder | تدمد: | 2666-6367 |
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| DOI: | 10.1016/j.jtct.2022.04.014 |