Extracorporeal Photopheresis (ECP) is a cell-based immunomodulatory therapeutic procedure reimbursable by the Centers for Medicare and Medicaid Services for patients with chronic Graft versus Host Disease (cGVHD) refractory to standard immunosuppressive drug treatment. The objective was to examine real-world second-line systemic treatment(2LST) patterns and associated costs among cGVHD patients.

A retrospective analysis was conducted using Truven Health MarketScan^® Commercial and Medicare Supplemental claims databases (2009–2016). Adult cGVHD patients receiving 2LST, with continuous enrolment (3 months prior to 1st cGVHD diagnosis and 6 months post 2LST initiation) were included. Treatment patterns, healthcare resource utilization and costs, including key cost drivers, post 2LST were examined.

Of the 3086 eligible patients, 464 met the inclusion criteria (60.1% males; mean age of 49.7 years). On average, 2LST was initiated 5.4 months after the 1st cGVHD diagnosis. The most frequently used 2LSTs were mTOR inhibitors (293;63.2%), ECP (210,45%), and imatinib (51;11%). Of patients treated with ECP, nearly two-thirds (134;63.8%) received monotherapy, while over a third (76;36.2%) received combination therapy. Demographics and clinical characteristics of ECP and non-ECP treated patients were similar. There were no differences between patients receiving ECP mono- and ECP combination therapy. The average time to initiate ECP monotherapy after 1st cGVHD diagnosis was 6 months and 11 months for ECP combination therapy. Most patients who were initiated on other 2LST added ECP later. The average ECP treatment duration was 11 months. The average all-cause monthly total cost for study patients was $13,154 including $12,304, $584, and $265 for hospital, ER, and office visits respectively. Generalized linear model results revealed that male gender and pre-index total costs were associated with higher total cost.

Patients initiated 2LST 6 months after 1st cGVHD diagnosis and 1 in 2 received ECP therapy (mono- or combination). Demographics and clinical characteristics were similar between ECP and non-ECP treated patients. ECP monotherapy was initiated 5 months earlier than combination therapy. The average monthly all-cause total cost was $13,154 following the initiation of 2LST.

CITATION INFORMATION: Huang X., Joshi N., Luo L., Mitri G., Lovelace B., Pham A., Gao X. Treatment Patterns and Burden among Chronic Graft versus Host Disease Patients on Second-Line Systemic Treatments Including Extracorporeal Photopheresis Am J Transplant. 2017;17 (suppl 3).

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