Economic Impact of Post-Transplant Cytomegalovirus (CMV), Including Hematopoietic Stem Cell Transplant (HSCT) and Solid Organ Transplant (SOT) Recipients Experiencing Myelosuppression or Nephrotoxicity

Introduction CMV infection/disease is a cause of morbidity and mortality in HSCT/SOT recipients. Use of existing treatments (Txs) for CMV infection/disease is limited by toxicities (e.g. myelosuppression and nephrotoxicity). Understanding the economic impact of myelosuppression and nephrotoxicity among transplant recipients, notably those receiving Txs for CMV infection/disease, may provide valuable information on quantifying the burden of these comorbidities in this population. Objective To estimate healthcare costs in HSCT/SOT recipients treated for CMV infection/disease including patients (pts) diagnosed with myelosuppression/nephrotoxicity following Tx. Methods A retrospective, longitudinal cohort study using data from a US health claims database (PharMetrics Plus™; 2013–2017) identified HSCT/SOT recipients diagnosed with CMV and a subsequent prescription claim for Tx for CMV (CMV-Tx cohort), in addition to a Control cohort (no claim associated with CMV diagnosis or Tx). HSCT/SOT recipients with diagnosis claims of myelosuppression or nephrotoxicity on or following the date of Tx initiation were evaluated. The index date for CMV-Tx pts was the date of the first prescription claim after CMV diagnosis; the index date was imputed for controls. Healthcare costs for the subgroups were reported during the observation period (time from index date to the end of insurance coverage or data availability). Costs were reported per patient per month (PPPM) to account for varying lengths of observation period. Results There were 1,311 (412 HSCT and 899 SOT) pts in the CMV-Tx cohort. HSCT subgroup: 349 (84.7%) of CMV-Tx pts and 1,050 (63.3%) of controls had myelosuppression; nephrotoxicity was reported for 189 (45.9%) of CMV-Tx pts and 528 (31.8%) of controls. Mean observation periods for the HSCT CMV-Tx and Control cohorts were 13.73 and 15.32 months, respectively. SOT subgroup: 503 (56.0%) of CMV-Tx pts and 425 (20.0%) of controls had myelosuppression; 405 (45.1%) of CMV-Tx pts and 583 (27.4%) of controls had nephrotoxicity. Mean observation periods for the SOT CMV-Tx and Control cohorts were 18.82 and 14.34 months, respectively. Total medical costs for pts in the HSCT and SOT subgroups who had myelosuppression or nephrotoxicity (CMV-Tx and controls) were higher than in the respective HSCT/SOT full cohorts (Table). Inpatient visits were the main driver of costs in both HSCT and SOT subgroups (Table). Conclusions Using data from a large US claims dataset, this study demonstrates the higher economic burden among pts diagnosed and managed for CMV post transplant compared with those without CMV. Among transplant recipients diagnosed with myelosuppression and nephrotoxicity, medical costs were higher than among the overall study population. This further reflects the burden and the need to minimize the impact of these conditions in the post-transplant CMV population.