Among some patients with myelodysplastic syndromes (MDS), a higher frailty score appears to be linked with a greater risk of longer hospitalization and a higher overall cost of care, according to research published in JCO Oncology Practice.

MDS can have an expected median overall survival of less than a year in high-risk patients, as defined by Revised International Prognostic Scoring System (R-IPSS) criteria. Previous research has also indicated that frailty score and the presence of comorbidities predict worse clinical outcomes, including overall survival. Recently, a group of researchers used a machine learning algorithm to develop a 15-item frailty scale (FS-15), which appeared to be predictive of survival when included with the R-IPSS.

However, it has not previously been established whether the FS-15 predicts for other clinical outcomes, including hospitalization and cost of care. For this study, researchers evaluated the predictive ability of the FS-15 on health care utilization and overall cost of care.

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Overall, data from 461 patients were included. At enrollment, the median patient age was 74 years, 34.9% of patients were female, 28.4% of patients had R-IPSS low-risk disease, and 28.6% of patients were transfusion-dependent. All data were obtained from the Ontario subset of the Canadian MDS Registry and all costs were given in Canadian dollars; patients were followed during initial, continuation, and terminal disease phases.

Analysis showed that 81.1% of patients were hospitalized over the study period (2006-2020), with a mean length of hospital stay of 10.6 days. Further analysis showed that FS-15 score independent predicted hospitalization during the initial (P =.02) and continuation phases (P =.01), but not the terminal phase (P =.09).

Per patient, the mean standardized 30-day cost was $8499 Canadian dollars; this finding was driven by clinic visits and patient hospitalization. Furthermore, patient FS-15 score appeared to predict cost of care, though only during the initial phase (P = .02), after adjusting for age, the presence of comorbidities, R-IPSS score, and transfusion dependence.

“In conclusion, we demonstrate that frailty, and specifically the FS-15, predicts for clinically meaningful outcomes including hospitalization and costs of care in MDS above and beyond comorbidity and standard prognostic scores,” the authors wrote in their report.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, or device companies. Please see the original reference for a full list of authors’ disclosures. 


Mozessohn L, Li Q, Liu N, et al. Impact of frailty on health care resource utilization and costs of care in myelodysplastic syndromes. JCO Oncol Pract. Published online February 10, 2023. doi:10.1200/OP.22.00668