Healthcare Utilization And Cost Associated With Cytomegalovirus Infection Among Pediatric Allogeneic Hematopoietic Cell Transplant Recipients

Understanding the cost and healthcare utilization associated with cytomegalovirus (CMV) treatment is particularly important as new alternative agents for CMV prevention and treatment such as letermovir and anti-CMV cytotoxic T lymphocytes become available. Literature on the impact of CMV-related hospitalization in allogeneic hematopoietic cell transplant (alloHCT) pediatric patients is limited. We hypothesized that CMV infections post-alloHCT will result in increased length of stay (LOS) in hospital and higher healthcare costs. The aim of this study was to determine healthcare utilization and outcomes of CMV-related hospitalization in alloHCT patients using a single-center clinical database. This was a retrospective study of 240 children ages 3 months to 21 years old who were transplanted between 2005 and 2016. Impact of CMV-related length of stay and total healthcare costs were quantified. Factors associated with prolonged CMV viremia (>25 days) were also examined. The median age of patients was 9.5 years old. In at risk CMV patients, the incidence of CMV viremia was 38%, the median time to onset was 33 days (range 0-292 days), and the median time to resolution was 25 days (range 3-148 days). The median LOS in the first year post-alloHCT for patients with viremia was higher compared to those without viremia (101 days [range 25-319 days] vs 72 days [range 26-354 days], p In the regression analyses, the unadjusted association between CMV infection and LOS was 27.4 days (p=0.003). In multivariable analysis, patients with CMV infection had an average of 23.3 days (p=0.004) longer LOS compared to patients without infection [Table] and added hospital costs of US$45,443 (p=0.162) compared to patients without CMV infection. In multivariable analysis, alemtuzumab was associated with CMV viremia >25 days (p=0.027). In conclusion, CMV viremia is associated with prolonged LOS and higher healthcare costs and indicates a need for improved and cost-effective CMV prevention strategies. Further study into patient outcomes and costs in alloHCT pediatric populations is needed.