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This study describes the economic burden associated with cGVHD. Direct costs associated with specialised healthcare utilisation (inpatient admissions and outpatient visits), as well as indirect costs associated with sickness absence-associated productivity loss were estimated in patients who underwent allogeneic HSCT in Sweden between 2006 and 2015, linking population-based health and economic registers. To capture the period of chronic GVHD, patients were included who survived\u2009&gt;\u2009182\u00a0days post-HSCT (start of follow-up), and cGVHD was classified based on patient treatment records to correct for any diagnosis underreporting. Patients were classified as \u2018non-cGVHD\u2019 if they received no immunosuppressive treatment, \u2018mild cGVHD\u2019 if they received only systemic corticosteroid treatment or immunosuppressive treatment, or \u2018moderate\u2013severe cGVHD\u2019 if they received extracorporeal photopheresis (ECP) only, corticosteroid treatment and immunosuppressive treatment, or systemic corticosteroid treatment and ECP treatments. Patients with moderate\u2013severe cGVHD spent more time in healthcare, had higher healthcare resource costs and higher sickness absence-related productivity loss compared to patients with non- or mild cGVHD. The cumulative total costs during the first 3\u00a0years of follow-up were EUR 14,887,599, EUR 20,544,056, and EUR 47,811,835 for non-, mild, and moderate\u2013severe groups, respectively. The long-term costs incurred with cGVHD following HSCT continue to be very high and significantly impacted by cGVHD severity. This study adds real-world health resource and economic insight relevant for policy-makers and healthcare providers when considering the clinical challenge of balancing immunosuppression to reduce cGVHD.<\/jats:p>","DOI":"10.1007\/s10198-020-01249-x","type":"journal-article","created":{"date-parts":[[2020,12,4]],"date-time":"2020-12-04T11:03:12Z","timestamp":1607079792000},"page":"169-180","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Real-world study of direct medical and indirect costs and time spent in healthcare in patients with chronic graft versus host disease"],"prefix":"10.1007","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7671-9471","authenticated-orcid":false,"given":"Frida","family":"Schain","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nurgul","family":"Batyrbekova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1451-6804","authenticated-orcid":false,"given":"Johan","family":"Liwing","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Baculea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Webb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0520-4312","authenticated-orcid":false,"given":"Mats","family":"Remberger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Mattsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,12,4]]},"reference":[{"issue":"6","key":"1249_CR1","doi-asserted-by":"publisher","first-page":"778","DOI":"10.1038\/bmt.2016.18","volume":"51","author":"D Niederwieser","year":"2016","unstructured":"Niederwieser, D., Baldomero, H., Szer, J., Gratwohl, M., Aljurf, M., Atsuta, Y., Bouzas, L.F., Confer, D., Greinix, H., Horowitz, M., Iida, M., Lipton, J., Mohty, M., Novitzky, N., Nunez, J., Passweg, J., Pasquini, M.C., Kodera, Y., Apperley, J., Seber, A., Gratwohl, A.: Hematopoietic stem cell transplantation activity worldwide in 2012 and a SWOT analysis of the Worldwide Network for Blood and Marrow Transplantation Group including the global survey. 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Nurgul Batyrbekova is employed by Scandinavian Development Services, who received financial compensation from Janssen-Cilag for conducting statistical analysis. Simona Baculea is employed by Janssen and owns company shares. Johan Liwing is employed by Janssen and owns stocks and options. Thomas Webb was previously employed by Janssen Global Services; reports personal fees from Janssen during the conduct of the study; and is now employed by Eisai Ltd, UK. Mats Remberger and Jonas Mattsson declare they have no conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was approved by Stockholm ethics committee (dnr 2017\/1716\u201331\/1).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Data were collected from population-wide registers without the requirement for individual consent.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"All authors have approved the manuscript for submission. We declare that all authors have made substantial contributions to the study, drafted the work or revised it critically for important intellectual content, approved the version to be published, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"These findings were submitted as an abstract to the International Society for Pharmacoeconomics and Outcomes Research conference (18\u201322 May 2019) and presented as a poster. Supplementary Method Fig.\u00a0\n                      \n                      a was presented in a poster at the American Society for Blood and Marrow Transplantation conference (20\u201324 February 2019).","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Previous presentations"}}]}}