OBJECTIVES: With advances to treating acute graft-versus-host-disease (aGvHD), chronic graft-versus-host disease (cGvHD) has become a focus of morbidity following allogeneic hematopoietic stem cell transplantion. Given that cGvHD often presents years following a transplant, our objective was to estimate its burden of cost based on published estimates of incidence, morbidity, lost work time and survivorship. METHODS: Treatment pathways and adverse events were evaluated in terms of direct cost from published sources. Additional cost estimates for readmission and follow-up care were annualized and compared between non-cGvHD patients and grades I-IV of cGvHD over a 5 year horizon, based on studies conducted in the United States and United Kingdom. Indirect costs (or benefits) were calculated based on age-adjusted United States Census Bureau reported average wages, wage growth and the probability that with illness these would be foregone. RESULTS: The total burden of cost from cGvHD is far more poignant when viewing long-term and morbidity, mortality and consequent wages foregone, even as compared with the cost of transplant and normative follow-up. Relapse due to primary disease (29%) and cGvHD (22%) were reported by the literature to be the leading causes of premature mortality. This is important in the counter-factual scenario where patients might have returned to normal daily activities. With the burden of cost for cGvHD presented as a summation of direct and indirect components, aggressive upfront treatments may have a potential to reduce long-term complications and maintain the ability to return to daily functioning. From the societal perspective, an estimated $24,940,983,900.00 ($24.9B) in wages are lost from 43,750 years of foregone employment, yielding a total ten year cGvHD cost burden of $30,214,063,841.50 ($30.2B).     CONCLUSIONS: The human capital perspective should be considered in making policy recommendations for coverage of cGvHD treatments that affect those, including Central and South American patients, who survice acute complications of allogeneic transplantation.