Mortality, length of stay and costs associated with acute graft-versus-host disease during hospitalization for allogeneic hematopoietic stem cell transplantation

Jingbo Yu, Shreekant Parasuraman, Anshul Shah, Daniel Weisdorf

Research output: Contribution to journalArticlepeer-review

44 Scopus citations


OBJECTIVE: Acute graft-versus-host disease (aGVHD) is a common and life-threatening complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). The extent to which aGVHD increases inpatient costs associated with allo-HSCT has not been thoroughly evaluated. In this analysis, mortality, hospital length of stay (LOS) and costs associated with aGVHD during allo-HSCT admissions are evaluated.

METHODS: This is a retrospective analysis of discharge records from the National Inpatient Sample database for patients receiving allo-HSCT between 1 January 2009 and 31 December 2013. Allo-HSCT discharges with an aGVHD diagnosis were included in the aGVHD group and those without any graft-versus-host disease (GVHD) diagnosis comprised the non-GVHD group. Mortality, LOS and costs were compared between the two groups, as well as within subgroups, including age (<18 vs. ≥18 years) and survival status (alive vs. deceased) at discharge.

RESULTS: Overall, mortality (16.2% vs. 5.3%; p < .01), median hospital LOS (42.0 vs. 26.0 days; p < .01) and median total costs ($173,144 vs. $98,982; p < .01) were significantly increased in patients with aGVHD versus those without GVHD during hospitalizations for allo-HSCT, irrespective of age group. Patients with aGVHD who were <18 years of age had a lower mortality rate but greater hospital LOS and total costs versus patients aged ≥18 years. Patients who died during allo-HSCT hospitalization had longer LOS and incurred greater costs than those who survived in both the aGVHD and non-GVHD groups.

CONCLUSION: Occurrence of aGVHD during allo-HSCT admissions resulted in a tripling of the mortality rate and a near doubling of hospital LOS and total costs. In addition, death during allo-HSCT hospitalizations was associated with greater healthcare utilization and costs. Effectively mitigating aGVHD may improve survival and substantially reduce hospital LOS and costs for allo-HSCT.

Original languageEnglish (US)
Pages (from-to)983-988
Number of pages6
JournalCurrent Medical Research and Opinion
Issue number6
StatePublished - Jun 3 2019

Bibliographical note

Funding Information:
Writing assistance was provided by Jane Kovalevich, PhD (Complete Healthcare Communications, LLC [North Wales, PA], a CHC Group company), whose work was funded by Incyte Corporation (Wilmington, DE). Previous presentation : This study was previously presented at the 2017 meeting of the American Society of Health-System Pharmacists Midyear Clinical Meeting.

Publisher Copyright:
© 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group.


  • Hematopoietic stem cell transplantation
  • graft-versus-host disease
  • healthcare costs
  • resource utilization


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