OBJECTIVES: GVHD frequently occurs at an estimated rate between 30-70% post-Allo-HSCT. We reviewed published evidence to assess QOL, healthcare resource use and costs associated with GVHD post-allo-HSCT.

METHODS: Embase, MEDLINE, Cochrane databases and conference abstracts (AMCP, ASCO, ASH, ISPOR) were systematically searched from Jan-2008 to Nov-2018 for QOL and economic evidence in patients with hematologic malignancies undergoing allo-HSCT. Additional bibliographical and string searches were also conducted to gather relevant evidence.

RESULTS: A limited amount of published evidence was identified. Two studies measured QOL and both found that GVHD was associated with reduced QOL. Significant and clinically meaningful (>10 point) reductions of all QOL domains were reported in GVHD patients as measured by Short Form 36 Questionnaire, and on all function scales of QLQ-C30 (Perić 2016). Lower EQ-5D utilities were also found for patients with GVHD: 0.74 overall post-allo-HSCT vs. 0.67 with GVHD (Kurosawa 2014). GVHD was also associated with increased costs. A US claims database analysis found that allo-HSCT patients with acute GVHD experienced greater healthcare costs compared to those without GVHD (>$100,000 additional cost per patient; p<0.01) and also experienced 3 additional weeks of hospitalization after 1-year of follow-up (Grubb 2016). A US population analysis estimated that $5.2 billion would be used from 2015-2025 to treat chronic GVHD in 44,450 patients and $27 billion would be lost in wages and work productivity, demonstrating significant economic burden for health plans and from a societal perspective (Jones 2016). A Japan-based cost study found that grade III-IV GVHD was associated with longer hospitalization (p=0.01); a significant driver of increased costs (Kurita 2017).

CONCLUSIONS: GVHD is associated with reductions in QOL and increased healthcare/societal costs with longer hospitalization as one of the main drivers. Superior treatment strategies to prevent and treat GVHD are warranted to reduce significant humanistic and economic burden.