Impact of Preemptive Therapy for Cytomegalovirus on Hospitalizations and Cost after Hematopoietic Stem Cell Transplantation

IF 4.3 Q1 Medicine
Jiaqi Fang , Yiqi Su , Phaedon D. Zavras , Amit D. Raval , Yuexin Tang , Miguel-Angel Perales , Sergio Giralt , Anat Stern , Genovefa A. Papanicolaou
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引用次数: 12

Abstract

Cytomegalovirus (CMV) viremia occurs in 40% to 80% of CMV-seropositive (R+) recipients of allogeneic hematopoietic cell transplantation (HCT). The preemptive therapy (PET) strategy has reduced the risk of CMV end-organ disease (EOD) and associated mortality but may lead to substantial healthcare resource utilization (HCRU) and costs. Real-world data on the economic impact of PET is relevant for the evaluation of alternative strategies for CMV management. We examined the impact of clinically significant CMV treated with PET on inpatient length of stay (LOS), number of readmissions, and associated costs from day 0 through day 180 post-HCT.

This was a retrospective study of R+ adults who underwent peripheral blood or marrow allogeneic HCT at Memorial Sloan Kettering Cancer Center between March 2013 and December 2017. Patients were routinely screened for CMV by qPCR and received PET according to institutional standards of care. Data were extracted from electronic medical records and hospital databases. Itemized cost data per patient were obtained from the Vizient database, adjusted to 2017 dollars using inflation indices. Study outcomes included HCRU evaluated by inpatient LOS and inpatient cost in patients who received PET for clinically significant CMV (PET group) compared with those who did not receive PET (no PET group) and the frequency and cost of CMV-related readmissions compared with non CMV-related readmissions. We used generalized linear models to examine the incremental HCRU and costs associated with PET controlling for other potential factors. Of 357 patients, PET was initiated in 208 (58.3%), at a median of 35 days after HCT. By day 180, 23 patients (6.4%) had developed CMV EOD and 3 (.8%) had died of CMV. Compared with the no PET group, the PET group had a longer LOS for HCT admission (P = .0276), longer total LOS by day 180 (P = .0001), a higher number of readmissions (P = .0001), a higher mean inpatient cost for HCT admission ($189,389 versus $151,646; P = .0133), and a higher total inpatient cost ($297,563 versus $205,815; P < .0001). Among PET recipients, CMV-related readmissions were associated with higher mean cost per episode compared with non CMV-related readmissions ($165,455 versus $89,419; P = .005). CMV-related readmissions comprised 40.6% of total all-cause readmissions and incurred 55.9% of total all-cause readmission costs in PET recipients. Our data show that patients treated with currently available PET had greater inpatient HCRU and cost, by day 180 compared with patients who did not receive PET. The cost of CMV-related readmissions accounted for 56% of total readmission cost among PET recipients. Future studies are needed to examine the cost-effectiveness of alternative strategies for CMV management.

巨细胞病毒先发制人治疗对造血干细胞移植后住院和费用的影响
巨细胞病毒(CMV)病毒血症发生在40%至80%的巨细胞病毒血清阳性(R+)受体异体造血细胞移植(HCT)。先发制人治疗(PET)策略降低了巨细胞病毒终末器官疾病(EOD)和相关死亡率的风险,但可能导致大量的医疗资源利用(HCRU)和成本。关于PET经济影响的真实数据与CMV管理替代策略的评估相关。我们研究了经PET治疗的具有临床意义的巨细胞病毒对hct后第0至180天住院时间(LOS)、再入院次数和相关费用的影响。这是一项回顾性研究,研究对象为2013年3月至2017年12月期间在纪念斯隆凯特琳癌症中心接受外周血或骨髓同种异体HCT的R+成人。患者通过qPCR常规筛查巨细胞病毒,并根据机构护理标准接受PET。数据提取自电子病历和医院数据库。每位患者的逐项成本数据来自Vizient数据库,使用通胀指数调整为2017年美元。研究结果包括HCRU通过住院LOS和住院费用来评估接受PET治疗临床显著巨细胞病毒患者(PET组)与未接受PET治疗患者(未接受PET组)的HCRU,以及CMV相关再入院的频率和费用与非CMV相关再入院的比较。我们使用广义线性模型来检验与PET控制其他潜在因素相关的HCRU增量和成本。在357例患者中,208例(58.3%)在HCT后35天开始PET治疗。到第180天,23例(6.4%)发生巨细胞病毒EOD, 3例(0.8%)死于巨细胞病毒。与无PET组相比,PET组HCT入院时的住院时间更长(P = 0.0276), 180天的总住院时间更长(P = 0.0001),再入院次数更多(P = 0.0001), HCT入院的平均住院费用更高(189,389美元对151,646美元;P = 0.0133),住院总费用较高(297,563美元对205,815美元;P & lt;。)。在PET接受者中,与非cmv相关的再入院相比,cmv相关的再入院与每集平均费用较高相关(165,455美元对89,419美元;p = .005)。cmv相关再入院占PET患者全因再入院总费用的40.6%,占全因再入院总费用的55.9%。我们的数据显示,与未接受PET治疗的患者相比,接受目前可用PET治疗的患者在180天的住院HCRU和费用更高。与cmv相关的再入院费用占PET接受者总再入院费用的56%。未来的研究需要检验CMV管理的替代策略的成本效益。
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来源期刊
CiteScore
6.60
自引率
0.00%
发文量
1061
审稿时长
3-6 weeks
期刊介绍: Biology of Blood and Marrow Transplantation publishes original research reports, reviews, editorials, commentaries, letters to the editor, and hypotheses and is the official publication of the American Society for Transplantation and Cellular Therapy. The journal focuses on current technology and knowledge in the interdisciplinary field of hematopoetic stem cell transplantation.
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