HEALTHCARE RESOURCE UTILIZATION IN THE MANAGEMENT OF CHRONIC GRAFT VERSUS HOST DISEASE IN BRAZIL: RESULTS FROM A MULTI-REGIONAL DELPHI PANEL
- 1Sanofi, São Paulo, SP, Brazil
- 2ORIGIN Health, Barueri, SP, Brazil
- 3Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
Abstract
Introduction: Chronic graft-versus-host disease (cGVHD) is major long-term complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT), driving multisystem inflammation and fibrosis that progressively impairs organ function and quality of life. Data on healthcare resource utilization (HCRU) among cGVHD patients in Brazil remain limited, reflecting the complexity of disease management and regional variability in therapeutic access. Characterizing HCRU patterns is essential to inform health policy decisions and optimize care pathways for this population. Objective: To estimate annual HCRU among failure-free and treatment-failure cGvHD patients receiving ≥ 3 lines of systematic therapy within the Brazilian Supplementary Healthcare System. Methods: A modified Delphi panel comprising 11 specialists from 4 Brazilian regions was conducted through 2 online surveys followed by a live consensus discussion. Experts estimated annual HCRU across 3 categories (1) medical appointments (transplant specialists/hematologists, other specialists and multidisciplinary team consultations), (2) laboratory/ imaging tests, and (3) hospital care (emergency visits, ward/ intensive care unit [ICU] admissions), length of stay (LOS) and main hospitalization causes, stratified by clinical response (failure-free versus treatment-failure). Results are reported as median, mini-maxi values. Results: Failure-free patients had a median of 6 (4-52) annual appointments with transplant specialists and/or 5.5 (4-52) with hematologists versus 12 (3-52) and 8 (3-52) consultations, respectively in treatment-failure patients. Ophthalmologists and dermatologists were the most frequently consulted specialists in both groups: failure-free [3.5 (2-5) and 4 (3-5)] and treatment-failure [4.3 (2-10) and 4 (4-10)] with treatment-failure also showing increased pulmonologists [4 (1-12)] and infectious disease specialists [3 (0-12)] and multidisciplinary consultations [26.38 (17-208)] utilization. Laboratory/ imaging use mirrored consultation frequency, rising with treatment-failure. For hospital care, failure-free patients had a median of 2 (1-4) ward admissions with LOS of 7 (5–10) days, 2.5 (0-4) annual emergency visits and minimal ICU admissions [0 (0-2)]. In contrast, treatment-failure patients required a median of 3 (3–5) ward admissions with LOS of 14 (14–30) days, 4.3 (0–6) emergency visits and 1 (1–3) ICU annual admission with LOS of 7 (7–21) days. Infections were the leading cause of hospitalization across both groups. Discussion: Treatment-failure patients consume substantially more healthcare resources than failure-free patients across all resources categories with infections as the predominant driver of hospitalization, reflecting the immuno-compromised state of this population. Wide HCRU ranges highlight practice heterogeneity across the country. Conclusion: This study quantifies the substantial HCRU burden of cGVHD ≥ 3L in Brazil, providing context-specific inputs for economic evaluations and health technology assessments for novel cGvHD therapies in this setting.
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BibTeX
@article{dias2026healthcare,
title = {{HEALTHCARE RESOURCE UTILIZATION IN THE MANAGEMENT OF CHRONIC GRAFT VERSUS HOST DISEASE IN BRAZIL: RESULTS FROM A MULTI-REGIONAL DELPHI PANEL}},
author = {Carolina Zampirolli DIAS and Luiz SANTORO NETO and Ana Carolina Padula Ribeiro PEREIRA and Enzo Waiti ASANO and Sarah Franco WATANABE and Frederico Jose Bighetti MAGRO and Vanderson ROCHA},
journal = {Hematology, Transfusion and Cell Therapy},
year = {2026},
month = oct,
doi = {10.1016/j.htct.2026.106875},
url = {https://doi.org/10.1016/j.htct.2026.106875},
note = {CC BY},
}
RIS
TY - JOUR
TI - HEALTHCARE RESOURCE UTILIZATION IN THE MANAGEMENT OF CHRONIC GRAFT VERSUS HOST DISEASE IN BRAZIL: RESULTS FROM A MULTI-REGIONAL DELPHI PANEL
AU - Carolina Zampirolli DIAS
AU - Luiz SANTORO NETO
AU - Ana Carolina Padula Ribeiro PEREIRA
AU - Enzo Waiti ASANO
AU - Sarah Franco WATANABE
AU - Frederico Jose Bighetti MAGRO
AU - Vanderson ROCHA
PY - 2026
DA - 2026/10/23
JO - Hematology, Transfusion and Cell Therapy
DO - 10.1016/j.htct.2026.106875
UR - https://doi.org/10.1016/j.htct.2026.106875
AB - Introduction: Chronic graft-versus-host disease (cGVHD) is major long-term complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT), driving multisystem inflammation and fibrosis that progressively impairs organ function and quality of life. Data on healthcare resource utilization (HCRU) among cGVHD patients in Brazil remain limited, reflecting the complexity of disease management and regional variability in therapeutic access. Characterizing HCRU patterns is essential to inform health policy decisions and optimize care pathways for this population. Objective: To estimate annual HCRU among failure-free and treatment-failure cGvHD patients receiving ≥ 3 lines of systematic therapy within the Brazilian Supplementary Healthcare System. Methods: A modified Delphi panel comprising 11 specialists from 4 Brazilian regions was conducted through 2 online surveys followed by a live consensus discussion. Experts estimated annual HCRU across 3 categories (1) medical appointments (transplant specialists/hematologists, other specialists and multidisciplinary team consultations), (2) laboratory/ imaging tests, and (3) hospital care (emergency visits, ward/ intensive care unit [ICU] admissions), length of stay (LOS) and main hospitalization causes, stratified by clinical response (failure-free versus treatment-failure). Results are reported as median, mini-maxi values. Results: Failure-free patients had a median of 6 (4-52) annual appointments with transplant specialists and/or 5.5 (4-52) with hematologists versus 12 (3-52) and 8 (3-52) consultations, respectively in treatment-failure patients. Ophthalmologists and dermatologists were the most frequently consulted specialists in both groups: failure-free [3.5 (2-5) and 4 (3-5)] and treatment-failure [4.3 (2-10) and 4 (4-10)] with treatment-failure also showing increased pulmonologists [4 (1-12)] and infectious disease specialists [3 (0-12)] and multidisciplinary consultations [26.38 (17-208)] utilization. Laboratory/ imaging use mirrored consultation frequency, rising with treatment-failure. For hospital care, failure-free patients had a median of 2 (1-4) ward admissions with LOS of 7 (5–10) days, 2.5 (0-4) annual emergency visits and minimal ICU admissions [0 (0-2)]. In contrast, treatment-failure patients required a median of 3 (3–5) ward admissions with LOS of 14 (14–30) days, 4.3 (0–6) emergency visits and 1 (1–3) ICU annual admission with LOS of 7 (7–21) days. Infections were the leading cause of hospitalization across both groups. Discussion: Treatment-failure patients consume substantially more healthcare resources than failure-free patients across all resources categories with infections as the predominant driver of hospitalization, reflecting the immuno-compromised state of this population. Wide HCRU ranges highlight practice heterogeneity across the country. Conclusion: This study quantifies the substantial HCRU burden of cGVHD ≥ 3L in Brazil, providing context-specific inputs for economic evaluations and health technology assessments for novel cGvHD therapies in this setting.
SN - 2531-1379
SN - 2531-1387
ER -