PHARMACOECONOMIC ANALYSIS OF DIFFERENT METHODS FOR THE TREATMENT OF STEROID-REFRACTORY GRAFT-VERUS-HOST DISEASE: SINGLE-CENTER STUDY
Abstract
Introduction. Steroid-refractory graft-versus-host disease (srGVHD) is one of the most severe and life-threatening complications of allogeneic hematopoietic stem cell transplantation. Currently, there is no standard treatment for this complication. In addition, there is no data on the pharmacoeconomics of various methods in the Russian Federation. The objective is to compare the effectiveness and cost of treatment of acute and chronic srGVHD, as well as the use of different approaches in therapy. Material and methods. We have conducted a pilot study in 12 srGVHD patients treated with ruxolitinib and in 24 patients of wellmatched historical control, who treated with etanercept for the acute srGVHD and with extracorporeal photopheresis for chronic srGVHD. Results. The 6-month therapy of acute GVHD was associated with significantly higher cost than therapy of chronic GVHD (4.138±2.672 vs 1.862±1.122 thd. rub., р=0.004). The major factors driving up the costs were bacterial infections (р=0.022), opportunistic viral infections (р<0.001), severity of GVHD at the start of a therapy (р=0.013) and GI involvement (р=0.006). There was no difference in 1-year failure-free survival in acute (50 % vs 67 %, р=0.9) and chronic GVHD (87.5 % vs 87.5 %, р=1.0) between ruxolitinib and the control group, although the overall response was faster in ruxolitinib group (100 % vs 71 %, р=0.035, when assessed at 28 days in acute and 12 weeks in chronic srGVHD). The mean 6-month overall costs in the ruxolitinib were higher compared to the control group (1534 thd. rub. higher for acute and 541 thd. rub. higher for chronic GVHD), however this might be attributed to higher number of previous lines in the ruxolitinib group. Conclusions. It is revealed that the treatment of acute srGVHD requires significantly higher economic costs than chronic srGVHD. The power of this study does not allow to draw conclusions regarding the efficacy of different methods. Further studies are required to determine the optimal therapy of srGVHD.
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