The Cost of Chronic Graft Versus Host Disease

Chronic graft versus host disease (cGVHD) is a common complication for long-term survivors of allogeneic hematopoietic cell transplantation (HCT). Extended, intensive medical care and the inability to return to work can create a significant financial burden for patients that may impact their overall well-being. Betty Hamilton, MD, staff in the Department of Hematology and Medical Oncology, participated in a study through the Chronic GVHD Consortium to quantify the financial impact of chronic GVHD, recently presented at the American Society of Hematology annual meeting.

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The group found that a significant proportion of patients with chronic GVHD experience poor financial outcomes regardless of insured status. Of the 182 patients surveyed, 64 percent reported at least one financial challenge, including difficulty paying medical bills, running out of money month-to-month, using retirement savings, reducing spending on other expenses, borrowing money and selling assets. The inability to return to work, frequent physician visits, loss of insurance and need for multiple medications and treatments specific for cGVHD were associated with financial burden. Multivariate analysis showed that risk factors for financial burden included unemployment (OR 3.82; P = 0.02) and low household income (OR 11.8; P = 0.009).

“We also recently published data through the Chronic GVHD Consortium that demonstrated an association between socioeconomic status and patient-reported outcomes for cGVHD,” says Dr. Hamilton. “For instance, patients with higher income reported less severe cGVHD symptoms and better quality of life. The relationships among financial and social factors and disease outcomes are complex, but if we can determine risk factors, we can also create and time appropriate interventions.”

The group found no associations between financial burden and insurance type, cGVHD severity or physical and mental functioning. Over one third of patients had difficulty with insurance coverage for treatments recommended by their physicians.

“I think it’s clear that we need further investigation into the socioeconomic, psychosocial and biologic factors that affect cGHVD patients to improve outcomes for this group,” says Dr. Hamilton. “How can we better use resources that we may already have to improve care, and ensure that policies ensure adequate coverage and assistance for these vulnerable patients?”