Metabolic

Complications of steroid use for GVHD related to higher health care utilization, costs

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

A significant proportion of patients receiving steroids for graft versus host disease (GVHD) experience complications that increase both morbidity and the cost of treating GVHD, a common complication of hematopoietic cell transplantation Academy for Managed Care Pharmacy.

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

The study tracked nearly 700 patients who took steroids for GVHD for an average of 126 days, almost all (97%) of whom had at least 1 complication. In these patients, the costs associated with steroid-related complications were higher in those with prolonged steroid use and acute GVHD. According to the authors, the 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, have been documented.

“Most of the steroid-related health care costs for patients with complications were incurred in the first year of steroid use (94% of 2-year GI costs were incurred in the first year, 81% of metabolic / endocrine costs, 79% of infections , 77)% of the bone / muscle), ”wrote the abstract authors. “The health care costs associated with steroid complications were highest in those with an infection, and hospital stays were the largest contributor to costs.”

Hospital stays resulted in a median of $ 140,637 during the two years of follow-up, which reflected most of the median of $ 164,787 associated with steroid-related costs.

Median hospitalizations for steroid complications lasted about 20 days and were common in 26% to 72% of patients who developed complications. The length of hospital stay was the same for all types of complications.

The abstract authors noted several limitations to their research, including that health care resource use and costs associated with steroid-related complications were determined by the coding of the International Classification of Diseases, which has not been validated with medical records. The analysis also only included complications that led to resource use that is documented in medical information.

reference

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

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