Economic burden of preemptive treatment of CMV infection after allogeneic stem cell transplantation: a retrospective study of 208 consecutive patients View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2017-12-05

AUTHORS

Christine Robin, François Hémery, Christel Dindorf, Julien Thillard, Ludovic Cabanne, Rabah Redjoul, Florence Beckerich, Christophe Rodriguez, Cécile Pautas, Andrea Toma, Sébastien Maury, Isabelle Durand-Zaleski, Catherine Cordonnier

ABSTRACT

BackgroundCytomegalovirus (CMV) infection and disease (CMV episodes) are global concerns after allogeneic hematopoietic stem cell transplantation (HSCT). They affect survival, both by direct and indirect effects. Due to safety issues of current anti-CMV antivirals, long-term CMV prophylaxis is poorly tolerated and the most common strategy to decrease the incidence of CMV disease is preemptive. New, less toxic, molecules are currently being assessed for CMV prophylaxis which should replace or considerably decrease the preemptive approach. The aim of this study was to assess the economic burden of CMV episodes after HSCT with a preemptive approach.MethodsWe analyzed data from 208 consecutive adults transplanted in our institution, between 2008 and 2013. Hospital resource utilization was retrieved via the linked hospital admissions and Diagnostic Related Groups for the period of conditioning to 12 months after transplant.ResultsCMV episodes occurred in 70 patients (34%) over the first 12 months following HSCT, after a mean of 75 days (median: 46 (7–334)). The mean total length of stay was significantly associated with the occurrence of a CMV episode (113.9 vs. 87.5 days, p = 0.0002) but was associated neither with the pre-transplant CMV serology of donors/recipients nor with survival. The mean cost of transplant was €104,016 (SD = €37,281) after 12 months. Bivariate and multivariate analyses indicated that the occurrence of >1 CMV episode increased the costs of allogeneic HSCT by 25–30% (p < 0.0001).ConclusionOur study, which is the largest, single-institution cost study of allogeneic HSCT in Europe, shows that two or more CMV episodes significantly increased the transplant cost. New prophylactic strategies to prevent CMV infection and disease should decrease transplant costs. More... »

PAGES

747

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s12879-017-2854-2

DOI

http://dx.doi.org/10.1186/s12879-017-2854-2

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https://app.dimensions.ai/details/publication/pub.1095860529

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/29207952


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23 schema:description BackgroundCytomegalovirus (CMV) infection and disease (CMV episodes) are global concerns after allogeneic hematopoietic stem cell transplantation (HSCT). They affect survival, both by direct and indirect effects. Due to safety issues of current anti-CMV antivirals, long-term CMV prophylaxis is poorly tolerated and the most common strategy to decrease the incidence of CMV disease is preemptive. New, less toxic, molecules are currently being assessed for CMV prophylaxis which should replace or considerably decrease the preemptive approach. The aim of this study was to assess the economic burden of CMV episodes after HSCT with a preemptive approach.MethodsWe analyzed data from 208 consecutive adults transplanted in our institution, between 2008 and 2013. Hospital resource utilization was retrieved via the linked hospital admissions and Diagnostic Related Groups for the period of conditioning to 12 months after transplant.ResultsCMV episodes occurred in 70 patients (34%) over the first 12 months following HSCT, after a mean of 75 days (median: 46 (7–334)). The mean total length of stay was significantly associated with the occurrence of a CMV episode (113.9 vs. 87.5 days, p = 0.0002) but was associated neither with the pre-transplant CMV serology of donors/recipients nor with survival. The mean cost of transplant was €104,016 (SD = €37,281) after 12 months. Bivariate and multivariate analyses indicated that the occurrence of >1 CMV episode increased the costs of allogeneic HSCT by 25–30% (p < 0.0001).ConclusionOur study, which is the largest, single-institution cost study of allogeneic HSCT in Europe, shows that two or more CMV episodes significantly increased the transplant cost. New prophylactic strategies to prevent CMV infection and disease should decrease transplant costs.
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29 schema:keywords CMV disease
30 CMV episodes
31 CMV infection
32 CMV prophylaxis
33 CMV serology
34 ConclusionOur study
35 Diagnostic Related Groups
36 Europe
37 MethodsWe
38 admission
39 adults
40 aim
41 allogeneic hematopoietic stem cell transplantation
42 allogeneic stem cell transplantation
43 analysis
44 antivirals
45 approach
46 bivariate
47 burden
48 cell transplantation
49 common strategy
50 concern
51 conditioning
52 consecutive adults
53 consecutive patients
54 cost
55 cost studies
56 data
57 days
58 disease
59 donor/recipient
60 economic burden
61 effect
62 episodes
63 global concern
64 group
65 hematopoietic stem cell transplantation
66 hospital admission
67 hospital resource utilization
68 incidence
69 indirect effects
70 infection
71 institutions
72 issues
73 length
74 mean cost
75 mean total length
76 means
77 molecules
78 months
79 multivariate analysis
80 new prophylactic strategies
81 occurrence
82 patients
83 period
84 period of conditioning
85 preemptive approach
86 preemptive treatment
87 prophylactic strategies
88 prophylaxis
89 recipients
90 related groups
91 resource utilization
92 retrospective study
93 safety issues
94 serology
95 stay
96 stem cell transplantation
97 strategies
98 study
99 survival
100 total length
101 transplant
102 transplant costs
103 transplantation
104 treatment
105 utilization
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