Clinical and economic burden of pre-emptive therapy of cytomegalovirus infection in hospitalized allogeneic hematopoietic cell transplant recipients

Lynn El Haddad, Shashank S. Ghantoji, Anne K. Park, Marjorie V. Batista, Jonathan Schelfhout, Jack Hachem, Yadira Lobo, Ying Jiang, Gabriela Rondon, Richard Champlin, Roy F. Chemaly

Research output: Contribution to journalArticle

Abstract

Cytomegalovirus (CMV) infection remains a major complication after allogeneic hematopoietic cell transplantation (allo-HCT). We conducted a retrospective study to determine the clinical and economic burden of pre-emptive therapy (PET) for CMV infection in 100 consecutive hospitalized adult CMV positive serostatus allo-HCT recipients and compared their hospitalization cost with allo-HCT recipients hospitalized with graft vs host disease without CMV infection (control group) and across 19 US cancer centers for hospitalized patients with CMV infection between 2012 and 2015 (Vizient database). A total of 192 CMV episodes of PET for CMV infection occurred within 1 year post-HCT. PET consisted of ganciclovir (41% of episodes), foscarnet (40%), and valganciclovir (38%) with the longest average length of stay in foscarnet-treated patients (41 days). The average direct cost per patient admitted for PET was $116 976 (range: $7866-$641 841) compared with $12 496 (range: $2004-$43 069) in the control group (P <.0001). The total direct cost per encounter was significantly higher in patients treated with foscarnet and had nephrotoxicity ($284 006) compared with those who did not ($112 195). The average cost amongst the 19 US cancer centers, including our institution, was $42 327 with major disparities in cost and clinical outcomes. PET for CMV infection is associated with high economic burden in allo-HCT recipients.

Original languageEnglish (US)
Pages (from-to)86-95
Number of pages10
JournalJournal of medical virology
Volume92
Issue number1
DOIs
StatePublished - Jan 1 2020

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Cytomegalovirus Infections
Cell Transplantation
Economics
Foscarnet
Transplants
Costs and Cost Analysis
Cytomegalovirus
Therapeutics
Control Groups
Ganciclovir
Graft vs Host Disease
Infection Control
Transplant Recipients
Length of Stay
Neoplasms
Hospitalization
Retrospective Studies
Databases

Keywords

  • cost
  • cytomegalovirus
  • hematopoietic cell transplant
  • pre-emptive therapy

ASJC Scopus subject areas

  • Virology
  • Infectious Diseases

Cite this

Clinical and economic burden of pre-emptive therapy of cytomegalovirus infection in hospitalized allogeneic hematopoietic cell transplant recipients. / El Haddad, Lynn; Ghantoji, Shashank S.; Park, Anne K.; Batista, Marjorie V.; Schelfhout, Jonathan; Hachem, Jack; Lobo, Yadira; Jiang, Ying; Rondon, Gabriela; Champlin, Richard; Chemaly, Roy F.

In: Journal of medical virology, Vol. 92, No. 1, 01.01.2020, p. 86-95.

Research output: Contribution to journalArticle

El Haddad, Lynn ; Ghantoji, Shashank S. ; Park, Anne K. ; Batista, Marjorie V. ; Schelfhout, Jonathan ; Hachem, Jack ; Lobo, Yadira ; Jiang, Ying ; Rondon, Gabriela ; Champlin, Richard ; Chemaly, Roy F. / Clinical and economic burden of pre-emptive therapy of cytomegalovirus infection in hospitalized allogeneic hematopoietic cell transplant recipients. In: Journal of medical virology. 2020 ; Vol. 92, No. 1. pp. 86-95.
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