Extracorporeal photopheresis vs standard therapies for steroid‐refractory chronic graft‐vs‐host disease: Pharmacoeconomic assessment of hospital resource use in Spain

Background This study assessed pharmacoeconomic costs associated with extracorporeal photopheresis (ECP) compared with other available second‐line therapies for chronic graft‐vs‐host disease (cGvHD) in a tertiary Spanish institution. Methods Patients (≥18 years) diagnosed with steroid‐refractory cGv...

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Bibliographic Details
Published in:Journal of clinical apheresis 2021-08, Vol.36 (4), p.612-620
Main Authors: Boluda, Blanca, Solana‐Altabella, Antonio, Cano, Isabel, Acuña‐Cruz, Evelyn, Rodríguez‐Veiga, Rebeca, Ballesta‐López, Octavio, Megías‐Vericat, Juan Eduardo, Martínez‐Cuadrón, David, Gómez, Ines, Solves, Pilar, Lorenzo, Ignacio, Piñana, Jose Luis, Sanz, Jaime, Guerreiro, Manuel, Montoro Gómez, Juan, Díaz‐González, Alvaro, Marco, Javier, Blanco, Albert, Sanz, Miguel Á., Montesinos, Pau
Format: Article
Language:English
Subjects:
Adult
Aged
Apheresis
Chronic Disease
cost comparison
Cost control
Economics, Pharmaceutical
extracorporeal photopheresis
Female
Graft vs Host Disease - drug therapy
Graft vs Host Disease - economics
graft‐vs‐host disease
healthcare resource utilization
Hematopoietic Stem Cell Transplantation - methods
Hospitalization
Hospitals
Humans
Immunosuppressive Agents
Length of Stay
Male
Middle Aged
Outpatients
Patients
Pharmacoeconomics
Photodynamic therapy
Photopheresis - economics
Photopheresis - methods
Respiratory failure
Retrospective Studies
Risk
Spain - epidemiology
Steroids - therapeutic use
Treatment Outcome
Young Adult
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Summary:Background This study assessed pharmacoeconomic costs associated with extracorporeal photopheresis (ECP) compared with other available second‐line therapies for chronic graft‐vs‐host disease (cGvHD) in a tertiary Spanish institution. Methods Patients (≥18 years) diagnosed with steroid‐refractory cGvHD were eligible. Data were collected retrospectively from index date until 1 year or relapse. Patients were distributed in two cohorts (ECP vs non‐ECP), matched by age (≤ or > 40), hematopoietic stem cell transplant (HLA‐identical sibling donor or other) and number of previous immunosuppressive lines (1, 2, or ≥ 3). Costs were assigned using the 2016 diagnosis‐related group (DRG) system: DRG 579 (€22 383) overnight stay due to major complication (ie, sepsis, pneumonia, parenteral nutrition, or respiratory failure), and DRG 875 (€5154) if no major complication. The primary endpoint was healthcare resource utilization per patient. Results Forty patients (n = 20 per cohort) were included. Median age was 49, and 37.5% were female. Mean total cost per patient was €25 319 (95% CI: €17 049–€33 590) across the two cohorts, with a slightly lower mean cost per ECP‐treated patient (€23 120) compared with the non‐ECP cohort (€27 519; P = .597). Twenty‐seven inpatient hospitalizations occurred among ECP‐treated patients, vs 33 in the non‐ECP cohort. Day hospital and external consultations were more frequent in the ECP cohort. However, fewer inpatient admissions included DRG 579 compared with the non‐ECP cohort (44% vs 58%). Inpatient length of stay was slightly shorter in the ECP cohort (30 vs 49 days; P = .298). Conclusions ECP treatment may yield economic savings in Spain through resource savings and moving costs toward outpatient care.
ISSN:0733-2459
1098-1101
DOI:10.1002/jca.21901