Real-world study of direct medical and indirect costs and time spent in healthcare in patients with chronic graft versus
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ORIGINAL PAPER
Real‑world study of direct medical and indirect costs and time spent in healthcare in patients with chronic graft versus host disease Frida Schain1,2,3 · Nurgul Batyrbekova4,5 · Johan Liwing1,6 · Simona Baculea7 · Thomas Webb7 · Mats Remberger8 · Jonas Mattsson9,10,11 Received: 11 December 2019 / Accepted: 17 November 2020 © The Author(s) 2020
Abstract Chronic graft versus host disease (cGVHD) is a debilitating and costly complication following haemopoietic stem cell transplantation (HSCT). This study describes the economic burden associated with cGVHD. Direct costs associated with specialised healthcare utilisation (inpatient admissions and outpatient visits), as well as indirect costs associated with sickness absence-associated productivity loss were estimated in patients who underwent allogeneic HSCT in Sweden between 2006 and 2015, linking population-based health and economic registers. To capture the period of chronic GVHD, patients were included who survived > 182 days post-HSCT (start of follow-up), and cGVHD was classified based on patient treatment records to correct for any diagnosis underreporting. Patients were classified as ‘non-cGVHD’ if they received no immunosuppressive treatment, ‘mild cGVHD’ if they received only systemic corticosteroid treatment or immunosuppressive treatment, or ‘moderate–severe cGVHD’ if they received extracorporeal photopheresis (ECP) only, corticosteroid treatment and immunosuppressive treatment, or systemic corticosteroid treatment and ECP treatments. Patients with moderate–severe cGVHD spent more time in healthcare, had higher healthcare resource costs and higher sickness absence-related productivity loss compared to patients with non- or mild cGVHD. The cumulative total costs during the first 3 years of follow-up were EUR 14,887,599, EUR 20,544,056, and EUR 47,811,835 for non-, mild, and moderate–severe groups, respectively. The longterm costs incurred with cGVHD following HSCT continue to be very high and significantly impacted by cGVHD severity. This study adds real-world health resource and economic insight relevant for policy-makers and healthcare providers when considering the clinical challenge of balancing immunosuppression to reduce cGVHD. Keywords Chronic graft versus host disease · Economic burden · Direct medical costs · Indirect costs · Sweden JEL Classification E24 · H51 · I18
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10198-020-01249-x) contains supplementary material, which is available to authorized users. * Frida Schain [email protected] 1
Janssen Global Services, Stockholm, Sweden
2
Department of Medicine, Division of Hematology, Karolinska Institutet, Solna, Sweden
3
Schain Research, Bromma, Sweden
4
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
5
Scandinavian Development Services, Stockholm, Sweden
6
Department of Medicine, Division of Hematology, Karolinska Institutet, Huddinge, Sweden
7
Janssen Gl
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