568 - Healthcare Cost and Length of Stay for Cytomegalovirus (CMV) Infection-Related Hospitalizations in Allogeneic Hematopoietic Cell Transplant (allo-HCT) recipients: A Multicenter Analysis

Background: CMV reactivation is associated with significant morbidity and mortality in allo-HCT recipients and could be a resource intensive condition to manage. Limited data are available on the economic ramification of CMV reactivation in allo-HCT. Therefore, we aimed to examine healthcare cost and length of hospital stay (LOS) among allo-HCT recipients treated for CMV infection.

Methods: We performed a retrospective cohort study that included 56 consecutive allo-HCT recipients who were diagnosed with CMV infection within 100 days post-transplant and admitted to two medical centers, University of Texas MD Anderson Cancer Center and University of Chicago, Department of Infectious Disease between January 2016 and December 2017. CMV-related hospitalization was determined as an inpatient admission with or for CMV reactivation within 100 days post-transplant. Data were limited to only the first CMV-related hospitalization. Descriptive statistics were reported on patient characteristics, first CMV-related hospitalization and costs.  

Results: Most patients were 40 years or older (64%), female (55%), Caucasian (66%), CMV seropositive recipients (87%), received a matched unrelated donor HCT (49%) and had a myeloablative or reduced intensity conditioning regimen (65%) (Figure 1). The median duration of CMV episode was 40 days. Seventy-one percent of the patients were treated with foscarnet for CMV infection. Acute kidney injury was the most frequent CMV treatment-related complication (67%) followed by myelosuppression (55%) and end-stage renal disease (36%). Of 56 encounters, 16% required admission to intensive care unit with a median duration of 9 days. The median length of stay for hospitalization was 23 days and healthcare cost for CMV-related hospitalization was $71,840. The median hospitalization cost and LOS varied by reason for hospitalizations, type of anti-CMV therapy and treatment-related complications (Figure 2).Figure 1. Baseline characteristics, CMV episodes, outcomes, and cost.
Figure 2. CMV Outcomes among allo-HCT recipients


Conclusion: Our study showed even a single episode of CMV-related hospitalization led to significant resource use and hospitalization costs. This study highlights the need for interventions to prevent of CMV-related hospitalization, thereby reducing associated cost and resource use.