The economic burden of NIPC and BOS following allogeneic HSCT in patients with commercial insurance in the United States

Abstract

Non-infectious pulmonary complications (NIPC) after allogeneic hematopoietic stem cell transplantation (alloHSCT), including bronchiolitis obliterans syndrome (BOS), cause significant morbidity and mortality, but their impact on healthcare resource utilization (HRU) and costs is unknown. This longitudinal retrospective study quantified the economic burden of NIPC and BOS in alloHSCT patients using commercial claims data from the IQVIA PharMetrics Plus™ database. Study patients were aged 0-64 who underwent alloHSCT between 1/1/2006-9/30/2018 and observable 12 months before and up to 5 years after index alloHSCT. NIPC patients were identified using International Classification of Disease (ICD) diagnosis codes. Outcomes were mean per-patient HRU (inpatient admissions, outpatient office, hospital visits, and prescription medications) and costs paid by insurers in each post-transplant year. Among 2,162 alloHSCT patients, 254 developed NIPCs and 155; 147 were propensity score matched to non-NIPC patients. The The mean age was 43yrs and 46% were female. In the first year following transplantation, NIPC patients had significantly higher inpatient admission rates (3.8 ± 3.2 vs. non-NIPC: 2.6 ±2.4; p<0.001) and higher total costs, ($567,870 vs. $412,400; p=0.07), reflecting higher costs for inpatient admissions ($452,475 vs. $300,202; p=.06) and pulmonary function testing ($519 vs. $587; p<0.001). Among those observable for more years, costs remained higher for NIPC patients, reflecting significantly higher inpatient admission rates in the first three years following transplant. Sub-analysis of patients with diagnoses likely reflected of BOS were consistent with these findings. AlloHSCT patients who developed NIPC had higher healthcare resource utilization, and incurred higher costs, compared to alloHSCT patients who did not develop NIPC following transplant.