title: Treatment costs and survival in patients with grades III-IV acute graft-versus-host disease after allogenic hematopoietic stem cell transplantation during three decades.
abstract: To determine development of treatment, costs, and survival for patients with grades III/IV acute graft-versus-host disease (GVHD), data from 88 patients with grades III/IV acute GVHD were collected. The patients were divided into three groups: patients who received transplants from 1977 through 1989 (group A), 1990 through 1999 (group B), and 2000 through 2004 (group C). The costs for treatment, enumerated to year 2003 costs, were calculated. An increased 1-year survival rate was found in group C, at 21% versus 9% and 8% for groups A and B, respectively (P=0.02). Death by acute GVHD was increased by repeat transplantation (P<0.001), grade IV acute GVHD (P<0.001), human leukocyte antigen mismatch (P=0.009), and transplantation before 2000 (P=0.015). Transplantation after 1990 (P=0.003) and grade IV acute GVHD (P=0.03) were associated with higher treatment costs. It was found that the time the patients had GVHD did not differ among the three groups. In conclusion, the costs and survival rates associated with severe acute GVHD has increased in recent years.
authors.affiliation: Center for Allogeneic Stem Cell Transplantation and Division of Clinical Immunology, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden. britt-marie.svahn@karolinska.se
authors.forename: Britt-Marie
authors.initials: BM
authors.lastname: Svahn
authors.forename: Olle
authors.initials: O
authors.lastname: Ringdén
authors.forename: Mats
authors.initials: M
authors.lastname: Remberger
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D000935:Antifungal Agents / Q000191:economics / Q000627:therapeutic use; D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000191:economics* / Q000628:therapy*; D017048:Health Care Costs / Q000639:trends*; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics* / Q000639:trends; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D013997:Time Factors; D014184:Transplantation, Homologous / Q000191:economics* / Q000639:trends; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D000998:Antiviral Agents