Clinical and Economic Burden of Respiratory Viral Infections in Hematopoietic Stem Cell Transplant (HSCT) Recipients

Shashank S Ghantoji, The University of Texas School of Public Health


Background: Respiratory syncytial virus (RSV), Influenza virus (Flu) and parainfluenza virus (PIV) are common respiratory viral infections encountered in HSCT recipients and may be associated with high rates of pneumonia and mortality; however their economic burden has not been reported. Methods: Vizient (formerly UHC, University Health Consortium) clinical data base was utilized to assess the direct medical costs, including hospitalization and ICU admission rates, associated with RSV, Flu, and PIV from 19 cancer centers in U.S. over 36 months (October 2012 to September 2015). We also assessed respiratory viral infection associated length of hospital stay, ICU admission rates, length of ICU stay, and all-cause mortality between these cancer centers. For MDACC patient’s, predictors for higher cost of the encounters were assessed along with the cost-effectiveness of oral versus aerosolized ribavirin in the prevention of pneumonia in HSCT patients. Results: We estimated an overall cost burden of $46,824,078 associated with these infections in 19 centers during the study period. Average total cost per encounter was - for RSV ($49,054) and PIV ($46,113) and lower for Flu ($34,351). Major disparity in direct cost per patient between different centers was observed, irrespective of the type of virus. A total of 11,489 hospitalization days were attributed to these viral infections (RSV: 4,015 d, Influenza: 5,844 d, PIV: 1,630 d) with an average of 11 d per RSV, 9 d per Flu and 11 d per PIV infection. The average ICU admission rate was 19% for RSV, 15% for Flu and 23% for PIV. The average ICU days was 5 days for RSV, 9 days for Flu and 7 days for PIV infection. Of the 1,158 total encounters, an overall mortality rate of 7% (RSV: 9% [33/364], Flu: 6% [37/650], and PIV: 7% [11/144]) was observed. Length of stay, ICU admission and receiving IVIG were strong predictors of higher cost for all RVI’s. Preliminary estimates show that oral ribavirin is cost-effective compared to the aerosolized ribavirin form for the prevention of RSV pneumonia. Studies with larger sample size are needed for validation of this finding. Conclusion: This study underscores the significant economic and clinical burden of RSV, Flu, and PIV in HSCT recipients. Major disparities in direct costs for patient care across cancer centers in the U.S. were observed; the potential causes for these disparities should be explored further.

Subject Area

Economics|Public health|Health care management

Recommended Citation

Ghantoji, Shashank S, "Clinical and Economic Burden of Respiratory Viral Infections in Hematopoietic Stem Cell Transplant (HSCT) Recipients" (2017). Texas Medical Center Dissertations (via ProQuest). AAI10275948.