Quantifying the Clinical and Economic Burden of Graft-Versus-Host Disease Following Allogeneic Haematopoietic Stem Cell Transplantation in England: A Retrospective Cohort Study.
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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.