# Extended disability leave and related costs among employed patients with versus without graft-versus-host disease following hematopoietic stem cell transplantation

## TL;DR

Patients with graft-versus-host disease after stem cell transplants take more and longer disability leaves, costing more in lost productivity and healthcare.

## Contribution

Quantifies indirect costs of productivity loss due to GVHD using real-world disability claims data.

## Key findings

- Patients with GVHD had significantly higher rates of short- and long-term disability claims compared to those without GVHD.
- Disability leaves were longer and indirect costs were higher for patients with GVHD.
- All-cause healthcare costs were threefold higher in patients with GVHD.

## Abstract

Post–hematopoietic stem cell transplantation (HSCT) graft-versus-host disease (GVHD) is associated with considerable healthcare costs, and impaired productivity may represent an additional financial burden. This analysis quantified GVHD-associated indirect costs of productivity loss by comparing work-related disability leave claims between patients with versus without GVHD.

Patients with claims for HSCT in the IBM® MarketScan Commercial Database and the Health and Productivity Management Database between 1/1/09–12/31/19 and associated short- or long-term disability claims were included.

Of 354 patients with GVHD and 2629 patients without GVHD included in the analysis, a significantly greater percentage of patients with versus without GVHD had claims for short-term disability (GVHD, 43.5%; non-GVHD, 29.2%; P < 0.001), long-term disability (GVHD, 19.9%; non-GVHD, 6.3%; P < 0.001) or a combination of both (GVHD, 53.5%; non-GVHD, 30.5%; P < 0.001). Disability leaves were, on average, longer for patients with GVHD versus without GVHD (short-term, 103 vs 59 days, P < 0.001; long-term, 120 vs 92 days, P < 0.001). Mean indirect costs of workdays lost due to disability leave were significantly higher among those with versus without GVHD (short-term, $13,180 vs $7504, P < 0.001; long-term, $15,441 vs $11,850, P < 0.001). Mean all-cause healthcare costs were significantly higher among those with versus without GVHD (short-term leave: $295,241 vs $95,937, P < 0.001; long-term leave: $312,691 vs $94,285, P < 0.001).

Most full-time employed patients with GVHD took disability leave, accounting for approximately half (127/261) of their total workdays, incurring higher indirect costs than patients without GVHD. Additionally, all-cause healthcare costs were threefold higher in patients with versus without GVHD.