Incidence, economic burden, and treatment of acute respiratory tract infection in hematopoietic stem cell transplantation recipients using real world data in Japan: A retrospective claims data analysis
Creators: name: Wattanakamolkul, Kittima
name: Nakayama, Yoshikazu
Publisher: name: Taylor & Francis
Year: 2022
Subjects: subject: Medicine
subject: Sociology
subject: FOS: Sociology
subject: Immunology
subject: FOS: Clinical medicine
subject: Science Policy
subject: 110309 Infectious Diseases
subject: FOS: Health sciences

description: Acute respiratory tract infections (ARTIs) are common in hematopoietic stem cell transplantation (HSCT) recipients, however, data is limited regarding epidemiology and economic burden of ARTI in HSCT recipients in Japan. We evaluated incidence of ARTI in HSCT recipients, associated economic burden, and ARTI-related treatments post-HSCT. Patients receiving HSCT between July 2017 and December 2018, and those enrolled in Japanese Medical data Center (JMDC) database for ≥6 months before index month (month when latest medical procedure code of HSCT recorded), were included. The outcomes included demographics, ARTI incidence, healthcare resource utilization (HCRU), direct costs, and ARTI-related treatments. In 330 analyzed patients, ARTI incidence rate was 85.5% during total follow-up, consisting of post-HSCT hospitalization of mean 2.1 months and post-discharge periods of mean 17.6 months (post-HSCT hospitalization: 44.8%; post-discharge: 77.6%). For ARTI vs non-ARTI patients during post-HSCT hospitalization, length of hospitalization was significantly longer (mean [SD] months; 2.40 [1.73] vs 1.84 [1.09]; p = 0.0004), and median cost was significantly higher (JPY; 6,250,120.00 vs 4,774,570.00; p = 0.0096). The cost of outpatient visits during post-discharge periods, drug-related and non-drug-related costs of outpatient visits were generally higher for ARTI vs non-ARTI patients. In ARTI vs non-ARTI patients, utilization of any symptom relievers (decongestants, antitussives, and antipyretics), bronchodilators, immunoglobulin G, antibiotics, antivirals, and oxygen supply were numerically higher during post-HSCT hospitalization and post-discharge periods. Proportion of patients and mean prescription days for immunosuppressants during post-HSCT hospitalization were higher in ARTI vs non-ARTI patients. This administrative claims lack clinical data and contains only direct medical costs. Patients were retained if they had at least one month of enrollment post-HSCT. In HSCT recipients, ARTI leads to substantial incremental HCRU and direct cost for management in real-world setting in Japan. People receiving hematopoietic stem cell transplantation (HSCT) commonly suffer from acute respiratory infections (ARTIs). The real-world data on its incidence and economic impact in Japan is limited. In this study, using the Japanese Medical data Center (JMDC) claims database 330 HSCT recipients were identified during July 2017 and December 2018. Of these patients, 85.5% developed ARTI either during post-HSCT hospitalization (44.8%, within mean 2.1months) or post-discharge period (77.6%, within mean 17.6 months). Patients with ARTI had longer hospital stay (2.40 months vs. 1.84 months) and higher in-patient treatment cost (6,250,120.00 JPY vs. 4,774,570.00 JPY) than those without ARTI. The cost associated with out-patient treatment, both drug-related and non-drug-related, were also higher for ARTI patients than non-ARTI patients. The use of medicines for stuffy nose (decongestants), dry cough (antitussives) and fever (antipyretics) and other medicines to treat respiratory infections (such as bronchodilators, immunoglobulin G, antibiotics, antivirals, and oxygen supply) was generally high with ARTI patients both during post-HSCT hospitalization and during post-discharge periods. The use of immunosuppressants was also more in patients who acquired ARTI as compared with non-ARTI patients during post-HSCT hospitalization. This study demonstrates the significant impact of ARTI in terms of economic and healthcare resource utilization in HSCT recipients in Japan.