195 - Economic and Clinical Burden of Respiratory Virus Infections in Allogeneic Hematopoietic Cell Transplantation Recipients

Background: Respiratory viruses (RV), including respiratory syncytial virus (RSV), influenza, parainfluenza virus (PIV), and human metapneumovirus (HMPV), frequently lead to serious complications such as lower respiratory tract infections and death in allogeneic hematopoietic cell transplantation (HCT) recipients. We used a large US claims database to compare the total reimbursement (TR), health resource utilization (HRU) and clinical outcomes between HCT patients with and without RV infections (RVI).

Methods: We used the Decision Resources Group Real World Evidence Data Repository to identify HCT recipients with date of service for the procedure from 1/1/2012-12/31/2017. We estimated the reimbursements from submitted charges using a reimbursement to charge ratio of 0.425. We examined the study outcomes in the year following HCT in patients with and without RVI. We also used a generalized linear model to determine adjusted TR stratified by the presence or absence of any acute or chronic graft-versus-host diseases (GVHD) after adjusting for age, health plan, underlying disease, stem cell source, number of comorbidities, baseline costs, and follow-up time.

Results: The study included 13,363 patients, representing 22% of HCTs reported to CIBMTR for the study period, of which 1,368 (10%) were coded with an RVI in the year following HCT: 578 (4%) RSV, 687 (5%) influenza, 166 (1%) PIV, and 181 (1%) HMPV. Unadjusted median TR were $132,395 higher for any RVI ($139,439 RSV, $101,963 influenza, $185,041 PIV and $248,029 HMPV) compared to those without RVI (Table 1). Adjusted TR were significantly higher for patients with any RVI compared to patients without that infection (p< .01) with or without GVHD (Figure 1). Patients with any RVI had significantly longer length of stay (LOS) for the HCT hospitalization, readmission rate and LOS after HCT hospitalization compared to patients without RVI (p< 0.05) (Table 2). A significantly higher proportion of patients with any RVI had pneumonia as compared to patients without that infection, irrespective of presence of GVHD (p< .0001).Table 1: Total healthcare reimbursement within one year of undergoing allogeneic HCT for patients with and without respiratory viral infections
Figure 1: Adjusted total reimbursements within one year of undergoing allogeneic HCT for patients with and without respiratory viral infections
Table 2: Health resource utilization within one year of undergoing allogeneic HCT for patients with and without respiratory viral infections


Conclusion: Allogeneic HCT patients with RVI have a significantly higher burden of TR, health resource utilization and worse clinical outcomes such as pneumonia during one year of undergoing HCT, regardless of the presence of GVHD.

Presenting Author(s)

• 

  Michael G. Ison, MD MS

  Professor of Medicine (Infectious Diseases) and Surgery (Organ Transplantation)
  Northwestern University
  Chicago, Illinois

  Disclosure: Adagio : Consultant (Status: Ongoing); AiCuris () : Grant/Research Support; AlloVir : Consultant (Status: Ongoing); Celltrion () : Consultant; Cidara : Consultant (Status: Ongoing); Genentech () : Advisor or Review Panel member, Consultant, Grant/Research Support; Janssen () : Consultant, Grant/Research Support; Merck : DSMB (Status: Ongoing), Other Financial or Material Support (Status: Ongoing); SAB Biotherapuetics : DSMB (Status: Ongoing), Other Financial or Material Support (Status: Ongoing); Sequiris : DSMB (Status: Ongoing), Other Financial or Material Support (Status: Ongoing); Shionogi () : Consultant; Shire () : Grant/Research Support; Takeda : DSMB (Status: Ongoing), Other Financial or Material Support (Status: Ongoing); Viracor () : Consultant; Vitaeris : DSMB (Status: Ongoing), Other Financial or Material Support (Status: Ongoing)

  Slides Slides and Audio

Co-Author(s)

• NC

  Nelson Chao, MD

  Dr
  Duke
  Durham, North Carolina

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• 

  Francisco M. Marty, MD

  Associate Professor
  Brigham and Women's Hospital
  Boston, MA

  Disclosure: Allovir (Consultant)Amplyx (Consultant)Ansun (Scientific Research Study Investigator)Avir (Consultant)Cidara (Scientific Research Study Investigator)F2G (Consultant, Scientific Research Study Investigator)Kyorin (Consultant)Merck (Consultant, Grant/Research Support, Scientific Research Study Investigator)New England Journal of Medicine (Other Financial or Material Support, Honorarium for Video)Regeneron (Consultant, Scientific Research Study Investigator)ReViral (Consultant)Scynexis (Scientific Research Study Investigator)Symbio (Consultant)Takeda (Scientific Research Study Investigator)United Medical (Consultant)WHISCON (Scientific Research Study Investigator)
• SM

  Seung Hyun Moon, MD, MPA

  VP
  AlloVir
  Cambridge, Massachusetts

  Disclosure: AlloVir (Employee, Shareholder)
• ZZ

  Zhiji Zhang, MS

  Statistical Analyst
  Certara
  Jersey City, New Jersey

  Disclosure: AlloVir (Independent Contractor)
• AC

  Aastha Chandak, PhD

  Senior Manager, Head US Statistics
  Certara
  New York, New York

  Disclosure: AlloVir (Independent Contractor)