Complications of Steroid Use in GVHD Associated With Higher Health Care Usage, Costs

Jaime Rosenberg

For patients with acute and chronic graft-vs-host disease (GVHD), systemic treatment with steroids is the standard of care, and although steroid-related complications are common, the associated health care resource utilization and costs are not well documented.

A significant proportion of patients receiving steroids for graft-vs-host disease (GVHD) experience complications, adding to both the morbidity and cost of managing GVHD, a common complication of hematopoietic cell transplantation, according to new research presented at the annual meeting of the Academy of Managed Care Pharmacy.

For patients with acute and chronic GVHD, systemic treatment with steroids is the standard of care, and although steroid-related complications are common, the associated health care resource utilization and costs are not well documented.

The study followed nearly 700 patients who were taking steroids for GVHD for a median of 126 days, nearly all (97%) of whom had at least 1 complication. Among these patients, the costs associated with steroid-related complications were higher for those with prolonged steroid use and with acute GVHD. According to the authors, infection was the most common complication throughout the study period and was associated with the highest risk of hospitalization.

Other complications including bone/muscle, gastrointestinal (GI), and metabolic/endocrine complications were documented.

“Most of the steroid-related health care costs in those with complications occurred in the first year of steroid use (94% of 2-year GI costs occurred in the first year, 81% of metabolic/endocrine, 79% of infections, 77% of bone/muscle),” wrote the abstract authors. “Steroid complication‒related health care costs were greatest among patients with an infection, and hospitalizations contributed most to the costs.”

Hospitalizations resulted in a median of $140,637 throughout the 2 years of follow-up, reflecting most of the median $164,787 associated with steroid complication-related costs.

Hospital stays related to steroid complications lasted a median of approximately 20 days and were common, occurring in 26% to 72% of the patients who experienced a complication. The length of hospital stay was similar across all complication types.

The authors of the abstract noted several limitations of their research, including that health care resource utilization and costs associated with steroid-related complications were determined by International Classification of Diseases coding, which was not validated with medical records. The analysis also included only complications that resulted in resource utilization documented in medical claims.

Reference

Bell E, Yu J, Bhatt V, et al. Healthcare resource utilization of steroid-associated complications in patients with graft-versus-host disease. Presented at: Academy of Managed Care Pharmacy 2021; April 12-16, 2021. Abstract D22.