568. Healthcare Cost and Length of Stay for Cytomegalovirus (CMV) Infection-Related Hospitalizations in Allogeneic Hematopoietic Cell Transplant (allo-HCT) recipients: A Multicenter Analysis
Authors: Khawaja Fareed , Mullane Kathleen , El Haddad Lynn , Sassine Joseph , Heredia Ella Ariza , Tang Yuexin , Raval Amit D , Chemaly Roy F 
Published: January 2021

Abstract

Background
CMV reactivation is associated with significant morbidity and mortality in allo-HCT recipients and could be a resource intensive condition to manage. Limited data are available on the economic ramification of CMV reactivation in allo-HCT. Therefore, we aimed to examine healthcare cost and length of hospital stay (LOS) among allo-HCT recipients treated for CMV infection.

Methods
We performed a retrospective cohort study that included 56 consecutive allo-HCT recipients who were diagnosed with CMV infection within 100 days post-transplant and admitted to two medical centers, University of Texas MD Anderson Cancer Center and University of Chicago, Department of Infectious Disease between January 2016 and December 2017. CMV-related hospitalization was determined as an inpatient admission with or for CMV reactivation within 100 days post-transplant. Data were limited to only the first CMV-related hospitalization. Descriptive statistics were reported on patient characteristics, first CMV-related hospitalization and costs.

Results
Most patients were 40 years or older (64%), female (55%), Caucasian (66%), CMV seropositive recipients (87%), received a matched unrelated donor HCT (49%) and had a myeloablative or reduced intensity conditioning regimen (65%) (Figure 1). The median duration of CMV episode was 40 days. Seventy-one percent of the patients were treated with foscarnet for CMV infection. Acute kidney injury was the most frequent CMV treatment-related complication (67%) followed by myelosuppression (55%) and end-stage renal disease (36%). Of 56 encounters, 16% required admission to intensive care unit with a median duration of 9 days. The median length of stay for hospitalization was 23 days and healthcare cost for CMV-related hospitalization was $71,840. The median hospitalization cost and LOS varied by reason for hospitalizations, type of anti-CMV therapy and treatment-related complications (Figure 2).
Figure 1. Baseline characteristics, CMV episodes, outcomes, and cost.

Figure 2. CMV Outcomes among allo-HCT recipients

Conclusion
Our study showed even a single episode of CMV-related hospitalization led to significant resource use and hospitalization costs. This study highlights the need for interventions to prevent of CMV-related hospitalization, thereby reducing associated cost and resource use.

Disclosures
Kathleen Mullane, DO, Pharm D, FIDSA, FAST, MERCK (Advisor or Review Panel member, Research Grant or Support, Speaker’s Bureau) Ella Ariza Heredia, MD, Merck Sharp & Dohme (Grant/Research Support)Oxford Immunotec (Grant/Research Support) Yuexin Tang, PhD, Merck and Co., Inc. (Employee) Amit D. Raval, PhD, Merck and Co., Inc (Employee) Roy F. Chemaly, MD, MPH, FACP, FIDSA, Chimerix (Consultant, Research Grant or Support)Clinigen (Consultant)Merck (Consultant, Research Grant or Support)Novartis (Research Grant or Support)Oxford Immunotec (Consultant, Research Grant or Support)Shire/Takeda (Research Grant or Support)Viracor (Research Grant or Support)