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Introduction <p>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> Methods <p>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> Results <p>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%&#xa0;CI 1.30–1.35] versus 0.55 [95%&#xa0;CI 0.54–0.57]; cGVHD 1.18 [95%&#xa0;CI 1.15–1.22] versus 0.33 [95%&#xa0;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],<i> p</i> &lt; 0.05) and patients with cGVHD compared with patients without GVHD (mean [SD] £11,707 [£20,722] versus £5227 [£11,041]).</p> Conclusions <p>GVHD is associated with considerable burden in England, underscoring the urgent need for improved prevention and treatment options.</p>

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

  • 期刊论文

  • 发表日期：

    2025年10月6日

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  • Francesca Kinsella,
  • Nadia Quignot,
  • Stephanie H. Read,
  • Gaelle Gusto,
  • Kazue Kikuchi,
  • Dawn Reichenbach,
  • Anita Burrell,
  • Shicheng Weng,
  • Charlotte Pollet,
  • Kris Thiruvillakkat

摘要

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.