同种异体造血干细胞移植中 CMV 感染的临床和经济影响：一个中等收入国家的视角

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2024-06-21 DOI:10.1111/ctr.15375

Gin Gin Gan, Thevambiga Iyadorai, Noor Yuhyi Sulaiman, Najihah Hussein, Hany Ariffin

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引用次数: 0

摘要

背景巨细胞病毒感染（CMV）是异基因造血干细胞移植（AHSCT）后常见的并发症。CMV 感染会增加移植成本，但不同国家的经济负担程度可能有所不同。本研究旨在确定在中等收入国家接受 AHSCT 的患者中 CMV 感染对临床和经济的影响。方法共纳入 150 名接受 AHSCT 后的成人和儿童患者进行分析。除了 CMV 感染的发病率，还收集了移植物抗宿主疾病（GVHD）的数据。此外，还检索了 104 名患者的 AHSCT 标准住院费用以及 12 个月内与移植相关的任何额外支出。结果 CMV 感染、急性 GVHD 和慢性 GVHD 分别发生在 38.7%、60.7% 和 22.0% 的患者中。与未感染 CMV 的患者相比，CMV 感染患者的再入院率更高（67.2% 对 47.8%；P = 0.020）。HLA 同源异体 AHSCT 和 CMV 感染的额外支出分别为 11 712.25 马币/2 504.49 美元；p = 0.0001 和 5 807.24 马币/1 241.79 美元；p = 0.036。结论这项单中心研究表明，与接受配型相关移植的患者相比，接受 HLA-同种异体 AHSCT 后出现 CMV 感染的患者的移植费用更高。应开展进一步研究，评估 CMV 一级预防是否具有成本效益，尤其是对于接受 HLA 同源异体 AHSCT 的患者。

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Clinical and Economic Impact of CMV Infection in Allogeneic Hematopoietic Stem Cell Transplantation: Perspectives from a Middle-Income Nation

Background

Cytomegalovirus infection (CMV) is a common complication after allogeneic hematopoietic stem cell transplantation (AHSCT). CMV infection increases transplantation costs; however, the extent of the financial burden may vary in different countries. This study aims to determine the clinical and economic impact of CMV infection in patients undergoing AHSCT in a middle-income country.

Methods

A total of 150 adult and pediatric patients post-AHSCT were included for analysis. In addition to incidence of CMV infections, data on graft versus host disease (GVHD) were also collected. Standard hospital charges for AHSCT and any additional transplantation-related expenditure within 12 months were also retrieved in 104 patients.

Results

CMV infection, acute GVHD and chronic GVHD occurred in 38.7%, 60.7%, and 22.0% of patients, respectively. Patients with CMV infections had higher readmission rates compared to those who did not (67.2% vs. 47.8%; p = 0.020). Additional expenditure was seen in HLA-haploidentical AHSCT and CMV infection (MYR11 712.25/USD2 504.49; p < 0.0001 and MYR5 807.24/USD1 241.79; p = 0.036), respectively.

Conclusion

This single-center study demonstrated that patients who underwent HLA-haploidentical AHSCT and subsequently developed CMV infection had higher transplantation expenditures compared to those who had matched-related transplantation. Further studies should be conducted to evaluate if primary prophylaxis against CMV is cost-effective, especially in patients who undergo HLA-haploidentical AHSCT.

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.