A recent study revealed substantial healthcare resource utilization (HCRU) and costs linked to complications associated with steroid use for graft-versus-host disease (GVHD). The study’s findings were reported in the journal Transplantation and Cellular Therapy.1

The study was a retrospective analysis of claims found in the Optum® Research database for patients with GVHD following hematopoietic cell transplantation who received treatment with systemic steroids. Eligible patients had been treated between July 2010 and August 2019 for either acute GVHD, chronic GVHD, or both. The index date was the date of the first claim related to steroid use for GVHD, and patient data were analyzed from a baseline period of 6 months before the index date and for 2 years following the index date. Outcomes of interest were HCRU and costs related to complications of steroid use. The study evaluated 4 types of complications: bone/muscle, gastrointestinal, infection, and metabolic/endocrine.

The analysis included 689 patients, median age 55 years. Among these patients, 39% had both acute and chronic GVHD, 22% had only acute GVHD, 21% had only chronic GVHD, and 18% of patients had GVHD that was unspecified. Nearly all (97%) patients had at least 1 complication related to steroid use.

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Infections represented the most common type of complication, occurring in 79.5% of patients. Metabolic/endocrine complications occurred in 32.4%, gastrointestinal complications occurred in 29.2%, and bone/muscle complications occurred in 19.7%.

Hospitalization related to any steroid complication was reported as occurring in 66% of patients at least once. With hospitalizations, the median length of hospital stay was 20 days (IQR, 8-43). Across types of complications, the rate of hospitalization was highest with infections (72%).

For healthcare costs deemed potentially related to steroid complications, the total mean cost was $164,787, median cost was $50,834 (IQR, $8865-$182,693). Hospitalization accounted for the biggest expense, at a mean cost of $140,637, median cost $26,782 (IQR, $0-$141,398).

Among complications, the largest cost was seen with infections, at a mean cost of $167,473 and a median cost of $57,680 (IQR, $16,261-$178,698), mostly associated with inpatient costs. Higher total adjusted costs for treatment of GVHD also were due to infection, compared with no infection (P <.001). A similar pattern was seen for gastrointestinal and bone/muscle complications (P <.001 for each), but not for metabolic/endocrine complications (P =.37).

“This analysis demonstrated higher 2-year health care costs, HCRU, and hospitalization rates in patients who experienced one or more complications following steroid treatment for GVHD,” the study investigators reported. They also noted that in this analysis inpatient care accounted for most of the HCRU and costs.

Disclosures: Some authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Bell EJ, Yu J, Bhatt V, et al. Healthcare resource utilization and costs of steroid-associated complications in patients with graft-versus-host disease. Transplant Cell Ther. Published online April 25, 2022. doi:10.1016/j.jtct.2022.04.014