Indirect costs associated with premature mortality among those with veno-occlusive disease/sinusoidal obstruction syndrome with multiorgan dysfunction post-hematopoietic stem-cell-transplant

Figures & data

Figure 1 Schematic representation of the model.

Notes: Model inputs (in blue boxes) included annual incidence of HSCT by age, VOD/SOS by graft type (allogeneic and autologous), and VOD/SOS with MOD among HSCT patients. In turn, these values were inputs for the calculation of excess mortality associated with VOD/SOS with MOD (model outputs in purple boxes). The calculated excess mortality rates in each age-group were used to determine the cost of lost work productivity, which was calculated based on employment rates and mean salaries by age.
Abbreviations: alloHSCT, allogeneic HSCT; autoHSCT, autologous HSCT; HSCT, hematopoietic stem-cell transplant; MOD, multiorgan dysfunction; SOS, sinusoidal obstruction syndrome; VOD, veno-occlusive disease.

Table 1 Allogeneic and autologous HSCT and mortality by age-group (preretirement population)

Age, years	Patients, n (%)^Citation17			Mortality rate in patients receiving HSCT, %^Citation18
	Autologous (n=10,542)	Allogeneic (n=7,742)	Total (N=18,284)	Autologous	Allogeneic
≤20	248 (2.4)	1,461 (18.9)	1,710 (9.4)	2.8	30.6
21–30	688 (6.5)	917 (11.8)	1,605 (8.8)	7.2	27.9
31–40	688 (6.5)	917 (11.8)	1,605 (8.8)	6.1	26.0
41–50	1,578 (15.0)	1,354 (17.5)	2,932 (16.0)	5.9	30.0
51–60	3,247 (30.8)	1,760 (22.7)	5,007 (27.4)	6.6	38.9
61–64	819 (7.8)	267 (3.4)	1,085 (5.9)	7.6	43.4

Abbreviations: HSCT, hematopoietic stem-cell transplant.

Table 2 General population average annual salary, employment rate, and reduction in life expectancy for HSCT patients by age-group

Age, years	Salary (2013 US$)a,^Citation20	Age, years	Employment rate (2013, %)^Citation21,Citation22	Age, years	Reduction in life expectancy vs general population (%)b,^Citation22
15–24	15,642	≤20	34.6	≤20	29.5
25–34	38,126	21–30	66.9	21–30	28.8
35–44	50,755	31–40	74.9	31–40	28.1
45–54	53,508	41–50	75.5	41–50	28.6
55–64	49,621	51–60	68.8	51–60	29.5
		61–64	51.8	61–64	29.6
		65–69	30.0

Notes:

a Average salary was assumed to be the same for HSCT patients as for the general population.²³

b Reduced life expectancy was defined as percentage decrease in number of years that an HSCT patient is expected to live compared with the life expectancy of the general population. For example, a 25-year-old HSCT patient will have a life expectancy that is 28.8% lower than the 54.83-year life expectancy of a 25-year-old in the general population (54.83–[54.83×0.288]=39.04-year life expectancy). Life expectancy for the population aged 20–60 years was provided by published data,²² and percentage of reduction in life expectancy at age 60 years was used for the 61- to 64-year age-group.

Abbreviations: HSCT, hematopoietic stem-cell transplant.

Table 3 Deterministic sensitivity analysis modeling variables of work-productivity loss due to premature death from VOD/SOS with MOD vs HSCT survivors without VOD/SOS

Epidemiological inputs

Incidence of VOD/SOS

All criteria^Citation3

Baltimore criteriaa,^Citation3,Citation5,Citation12

Modified Seattle criteriaa,^Citation3,Citation6,Citation7,Citation12

Incidence of VOD/SOS with MOD (age-specific), ±25%b

Mortality of VOD/SOS with MOD

95% CI^Citation3

100% death rateb

Economic inputs

Retirement age (60 years, 70 years)

Reduction in employment rate in HSCT survivors by number of

years after HSCT, ±25%

Reduction in life expectancy in HSCT survivors compared with

general population, ±25%^Citation22

Average annual salary for HSCT survivors, ±25%^Citation20

Annual discount rate (0, 5%)

Notes:

a Based on published epidemiological studies, the incidence of VOD/SOS for allogeneic HSCT patients under Seattle and Baltimore criteria was estimated to be 13.8% and 8.8%, respectively, based on a retrospective study of 845 patients¹² and the ratio of incidence of VOD/SOS among autologous and allogeneic HSCT was estimated to be 0.674 (8.7%/12.9%) based on a meta-analysis of 135 studies.³ Therefore, the incidence of VOD/SOS for autologous HSCT patients was calculated to be 9.30% (13.8%×0.674) as per Seattle criteria or 5.93% (8.8%×0.674) as per Baltimore criteria.

b Model assumption.

Abbreviations: HSCT, hematopoietic stem-cell transplant; MOD, multiorgan dysfunction; SOS, sinusoidal obstruction syndrome; VOD, veno-occlusive disease.

Figure 2 Annual number of excess deaths in the total population across all ages (including patients aged >65 years).

Notes: Calculated as number of deaths among HSCT patients with VOD/SOS and MOD, based on published incidence and mortality rates (Tables 1–3),^3,11,12 minus the number of deaths among patients with VOD/SOS and MOD that were attributed to other (non-VOD/SOS and MOD) causes (eg, primary disease, other complications, and natural causes). Interim calculation by age and type of transplant (N=361). ^aAutoHSCT and alloHSCT combined may not add up to total due to rounding.
Abbreviations: alloHSCT, allogeneic HSCT; autoHSCT, autologous HSCT; HSCT, hematopoietic SCT; MOD, multiorgan dysfunction; SOS, sinusoidal obstruction syndrome; VOD, veno-occlusive disease.

Table 4 Lost work-productivity years and indirect costs (2014 US$) due to excess deaths from VOD/SOS with MOD vs HSCT survivors by age-group (preretirement population)

Age, years	Average per patient		AutoHSCT		AlloHSCT		Total
	Years lost	Productivity loss, $	Years lost	Productivity loss, $	Years lost	Productivity loss, $	Years lost	Productivity loss, $
≤20	42	545,758	210	2,718,468	1,321	17,088,530	1,532	19,806,998
21–30	39	766,937	517	10,110,962	800	15,659,254	1,317	25,770,215
31–40	30	709,146	394	9,460,337	618	14,863,818	1,012	24,324,155
41–50	20	509,327	598	15,627,667	571	14,901,960	1,169	30,529,627
51–60	10	238,264	595	14,926,732	315	7,899,147	910	22,825,879
61–64a	3	47,122	39	736,170	12	219,128	51	955,298
Total	17b	343,791b	2,353	53,580,337	3,637	70,631,836	5,990	124,212,173

Note:

a No costs were observed for individuals aged ≥65 years;

b total for these two columns is the average total.

Abbreviations: AlloHSCT, allogeneic hematopoietic stem-cell transplant; autoHSCT, autologous HSCT; MOD, multiorgan dysfunction; SOS, sinusoidal obstruction syndrome; VOD, veno-occlusive disease.

Figure 3 Total work-productivity loss associated with premature death due to VOD/SOS with MOD by age and graft type compared to HSCT survivors.

Abbreviations: alloHSCT, allogeneic HSCT; autoHSCT, autologous HSCT; HSCT, hematopoietic SCT; MOD, multiorgan dysfunction; SOS, sinusoidal obstruction syndrome; VOD, veno-occlusive disease.

Figure 4 Deterministic sensitivity analysis: total work-productivity loss due to VOD/SOS with MOD compared with HSCT survivors.

Abbreviations: HSCT, hematopoietic stem-cell transplant; MOD, multiorgan dysfunction; SOS, sinusoidal obstruction syndrome; VOD, veno-occlusive disease.

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