Francesca Kinsella, Nadia Quignot, Stephanie H Read, Gaelle Gusto, Kazue Kikuchi, Dawn Reichenbach, Anita Burrell, Shicheng Weng, Charlotte Pollet, Kris Thiruvillakkat
{"title":"量化英国同种异体造血干细胞移植后移植物抗宿主病的临床和经济负担：一项回顾性队列研究","authors":"Francesca Kinsella, Nadia Quignot, Stephanie H Read, Gaelle Gusto, Kazue Kikuchi, Dawn Reichenbach, Anita Burrell, Shicheng Weng, Charlotte Pollet, Kris Thiruvillakkat","doi":"10.1007/s12325-025-03355-9","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Evidence on the burden of graft-versus-host disease (GVHD) among allogeneic haemopoietic stem cell transplantation (allo-HSCT) recipients in England is lacking. We compared clinical and economic outcomes among adult allo-HSCT recipients who developed acute GVHD (aGVHD) or chronic GVHD (cGVHD) versus those who did not develop GVHD.</p><p><strong>Methods: </strong>This retrospective cohort study included adult patients with haematological malignancies who underwent allo-HSCT in England between 2011 and 2023 and were captured in the National Cancer Registration and Analysis Service database. Patients were grouped according to GVHD development following allo-HSCT. Propensity score matching was used to balance covariates between aGVHD, cGVHD and without-GVHD groups. Clinical (mortality, severe infections) and economic (healthcare resource utilization, costs) outcomes observed during follow-up were extracted from the Hospital Episode Statistics database and were compared across GVHD groups.</p><p><strong>Results: </strong>Among 9450 eligible patients, 5022 (53.14%) developed GVHD. Hazard ratios (95% confidence intervals [CI]) indicated that patients with GVHD were at increased risk of mortality (aGVHD 1.61 [1.49-1.75]; cGVHD 2.12 [1.83-2.44]) and severe infection (aGVHD 1.94 [1.79-2.10]; cGVHD 3.11 [2.45-3.95]) versus patients without GVHD. Patients with GVHD had considerably greater overnight hospitalization rates than patients without GVHD (aGVHD 1.32 [95% CI 1.30-1.35] versus 0.55 [95% CI 0.54-0.57]; cGVHD 1.18 [95% CI 1.15-1.22] versus 0.33 [95% CI 0.32-0.35] overnight hospitalization rate per person-year, respectively). Total healthcare costs were approximately doubled for both patients with aGVHD compared with patients without GVHD (mean [standard deviation (SD)] £12,026 [£21,325] versus £6916 [£14,767], p < 0.05) and patients with cGVHD compared with patients without GVHD (mean [SD] £11,707 [£20,722] versus £5227 [£11,041]).</p><p><strong>Conclusions: </strong>GVHD is associated with considerable burden in England, underscoring the urgent need for improved prevention and treatment options.</p>","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":" ","pages":""},"PeriodicalIF":4.0000,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Quantifying the Clinical and Economic Burden of Graft-Versus-Host Disease Following Allogeneic Haematopoietic Stem Cell Transplantation in England: A Retrospective Cohort Study.\",\"authors\":\"Francesca Kinsella, Nadia Quignot, Stephanie H Read, Gaelle Gusto, Kazue Kikuchi, Dawn Reichenbach, Anita Burrell, Shicheng Weng, Charlotte Pollet, Kris Thiruvillakkat\",\"doi\":\"10.1007/s12325-025-03355-9\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Evidence on the burden of graft-versus-host disease (GVHD) among allogeneic haemopoietic stem cell transplantation (allo-HSCT) recipients in England is lacking. We compared clinical and economic outcomes among adult allo-HSCT recipients who developed acute GVHD (aGVHD) or chronic GVHD (cGVHD) versus those who did not develop GVHD.</p><p><strong>Methods: </strong>This retrospective cohort study included adult patients with haematological malignancies who underwent allo-HSCT in England between 2011 and 2023 and were captured in the National Cancer Registration and Analysis Service database. Patients were grouped according to GVHD development following allo-HSCT. Propensity score matching was used to balance covariates between aGVHD, cGVHD and without-GVHD groups. Clinical (mortality, severe infections) and economic (healthcare resource utilization, costs) outcomes observed during follow-up were extracted from the Hospital Episode Statistics database and were compared across GVHD groups.</p><p><strong>Results: </strong>Among 9450 eligible patients, 5022 (53.14%) developed GVHD. Hazard ratios (95% confidence intervals [CI]) indicated that patients with GVHD were at increased risk of mortality (aGVHD 1.61 [1.49-1.75]; cGVHD 2.12 [1.83-2.44]) and severe infection (aGVHD 1.94 [1.79-2.10]; cGVHD 3.11 [2.45-3.95]) versus patients without GVHD. Patients with GVHD had considerably greater overnight hospitalization rates than patients without GVHD (aGVHD 1.32 [95% CI 1.30-1.35] versus 0.55 [95% CI 0.54-0.57]; cGVHD 1.18 [95% CI 1.15-1.22] versus 0.33 [95% CI 0.32-0.35] overnight hospitalization rate per person-year, respectively). 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引用次数: 0
摘要
在英国，关于同种异体造血干细胞移植（alloo - hsct）受者移植物抗宿主病（GVHD）负担的证据缺乏。我们比较了发生急性GVHD （aGVHD）或慢性GVHD （cGVHD）与未发生GVHD的成人同种异体移植受体的临床和经济结果。方法：这项回顾性队列研究包括2011年至2023年间在英国接受同种异体造血干细胞移植的成年血液恶性肿瘤患者，并在国家癌症登记和分析服务数据库中捕获。根据同种异体移植后GVHD的发展情况对患者进行分组。倾向评分匹配用于平衡aGVHD、cGVHD和非gvhd组之间的协变量。从医院事件统计数据库中提取随访期间观察到的临床（死亡率，严重感染）和经济（医疗资源利用，成本）结果，并在GVHD组之间进行比较。结果：9450例符合条件的患者中，5022例（53.14%）发生GVHD。风险比（95%可信区间[CI]）显示，GVHD患者的死亡风险（aGVHD 1.61 [1.49-1.75]; cGVHD 2.12[1.83-2.44]）和严重感染风险（aGVHD 1.94 [1.79-2.10]; cGVHD 3.11[2.45-3.95]）高于无GVHD患者。GVHD患者的过夜住院率明显高于非GVHD患者（aGVHD分别为1.32 [95% CI 1.30-1.35]和0.55 [95% CI 0.54-0.57]； cGVHD分别为1.18 [95% CI 1.15-1.22]和0.33 [95% CI 0.32-0.35]）。与没有GVHD的患者相比，aGVHD患者的总医疗费用大约翻了一倍(平均[标准差（SD）] 12,026英镑[21,325英镑]对6916英镑[14,767英镑]，p结论：GVHD在英国与相当大的负担相关，强调迫切需要改进预防和治疗方案。
Quantifying the Clinical and Economic Burden of Graft-Versus-Host Disease Following Allogeneic Haematopoietic Stem Cell Transplantation in England: A Retrospective Cohort Study.
Introduction: Evidence on the burden of graft-versus-host disease (GVHD) among allogeneic haemopoietic stem cell transplantation (allo-HSCT) recipients in England is lacking. We compared clinical and economic outcomes among adult allo-HSCT recipients who developed acute GVHD (aGVHD) or chronic GVHD (cGVHD) versus those who did not develop GVHD.
Methods: This retrospective cohort study included adult patients with haematological malignancies who underwent allo-HSCT in England between 2011 and 2023 and were captured in the National Cancer Registration and Analysis Service database. Patients were grouped according to GVHD development following allo-HSCT. Propensity score matching was used to balance covariates between aGVHD, cGVHD and without-GVHD groups. Clinical (mortality, severe infections) and economic (healthcare resource utilization, costs) outcomes observed during follow-up were extracted from the Hospital Episode Statistics database and were compared across GVHD groups.
Results: Among 9450 eligible patients, 5022 (53.14%) developed GVHD. Hazard ratios (95% confidence intervals [CI]) indicated that patients with GVHD were at increased risk of mortality (aGVHD 1.61 [1.49-1.75]; cGVHD 2.12 [1.83-2.44]) and severe infection (aGVHD 1.94 [1.79-2.10]; cGVHD 3.11 [2.45-3.95]) versus patients without GVHD. Patients with GVHD had considerably greater overnight hospitalization rates than patients without GVHD (aGVHD 1.32 [95% CI 1.30-1.35] versus 0.55 [95% CI 0.54-0.57]; cGVHD 1.18 [95% CI 1.15-1.22] versus 0.33 [95% CI 0.32-0.35] overnight hospitalization rate per person-year, respectively). Total healthcare costs were approximately doubled for both patients with aGVHD compared with patients without GVHD (mean [standard deviation (SD)] £12,026 [£21,325] versus £6916 [£14,767], p < 0.05) and patients with cGVHD compared with patients without GVHD (mean [SD] £11,707 [£20,722] versus £5227 [£11,041]).
Conclusions: GVHD is associated with considerable burden in England, underscoring the urgent need for improved prevention and treatment options.
期刊介绍：
Advances in Therapy is an international, peer reviewed, rapid-publication (peer review in 2 weeks, published 3–4 weeks from acceptance) journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of therapeutics and interventions (including devices) across all therapeutic areas. Studies relating to diagnostics and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged.
The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Advances in Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.
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