Clinical and Economic Impact of Cytomegalovirus Infection among Children Undergoing Allogeneic Hematopoietic Cell Transplantation

• Published in: Biology of blood and marrow transplantation Vol. 25; no. 6; pp. 1253 - 1259
• Main Authors: Rastogi, Sonal, Ricci, Angela, Jin, Zhezhen, Bhatia, Monica, George, Diane, Garvin, James H., Hall, Matthew, Satwani, Prakash
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2019
• Subjects: Bone marrow transplantation; Child; Children; Cytomegalovirus; Cytomegalovirus Infections - economics; Cytomegalovirus Infections - virology; Female; Healthcare utilization; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic Stem Cell Transplantation - methods; Humans; Male; Retrospective Studies; Transplantation Conditioning - adverse effects; Transplantation Conditioning - methods; Bone marrow transplantation; Cytomegalovirus; Children; Healthcare utilization
• ISSN: 1083-8791; 1523-6536
• DOI: 10.1016/j.bbmt.2018.11.028

•Cytomegalovirus (CMV) infection is associated with longer hospitalization.•CMV infection results in higher cost of allogeneic hematopoietic cell transplantation.•Increased costs are associated with a higher incidence of post-transplantation complications. The literature on the impact of cytomegalovirus (CMV)-related hospitalization in pediatric allogeneic hematopoietic cell transplantation (alloHCT) recipients is limited. The aim of this study was to determine utilization and outcomes of CMV-related hospitalization in alloHCT recipients using a single-center clinical database. This was a retrospective study of 240 children aged 3 months to 21 years (median age, 9.5 years) who underwent alloHCT between 2005 and 2016. The impacts of CMV-related length of stay (LOS) and total healthcare costs were quantified. Factors associated with prolonged CMV viremia (>25 days’ duration) were also examined. In at-risk patients with CMV infection, the incidence of CMV viremia was 38% (59 of 155), the median time to onset was 33 days (range, 0 to 292 days), and the median time to resolution was 25 days (range, 3 to 48 days; n = 53). CMV infection was associated with a 23.3-day increase in LOS (P = .004) and added hospital costs of $45,443 (P = .162) compared with patients without CMV infection. In multivariable analysis, receipt of alemtuzumab (P = .027) was associated with CMV viremia of >25 days’ duration. Our data show that CMV viremia is associated with prolonged LOS and higher hospital costs and indicate the need for improved and cost-effective CMV prevention strategies. Further studies of patient outcomes and costs in pediatric alloHCT recipients is needed.