Costs of allogeneic hematopoietic cell transplantation with high-dose regimens.

Publication Type:

Journal Article

Source:

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation, Volume 14, Issue 2, p.197-207 (2008)

Keywords:

2008, Adult, Clinical Research Division, Costs and Cost Analysis, Data Collection, Female, Hematologic Neoplasms, hematopoietic stem cell transplantation, Humans, Length of Stay, Male, Middle Aged, Multivariate Analysis, Survival Analysis, Transplantation, Homologous, Treatment Outcome

Abstract:

To characterize the costs of allogeneic hematopoietic cell transplantation with high-dose regimens (HDCT), we analyzed clinical information and costs of 315 HDCT recipients during a 4-year study period beginning in 2000. Multivariate analyses were performed to identify pre- and/or post-HDCT factors predicting higher costs within the first year. Overall survival (OS) at 100 days and 1 year were 80% and 58%, respectively. The median cost and days of hospitalization were $102,574 in 2004 US dollars and 36 days in the hospital for 100 days, and $128,800 and 39 days in the hospital for 1 year. Early costs, defined as costs within the first 100 days, accounted for 84% of total costs within the first year. Inpatient costs comprise 94% of the early costs, but only 61% of the later costs defined as costs incurred between 101 days and 1 year. Of the pre-HDCT factors, unrelated donors and advanced disease risk were significantly associated with increased cost. When post-HDCT events were also considered, these pre-HDCT factors were no longer independently predictive of high cost. Instead, severe complications post-HDCT were associated with higher costs, increasing total costs $20,228 on average. If no complications occurred, the mean cost within the first year was $79,222. These results provide cost estimates for complicated and uncomplicated HDCT procedures, as well as costs for management of specific transplant complications.