Costs and Cost-Effectiveness of Hematopoietic Cell Transplantation

Preussler, Jaime M.; Denzen, Ellen M.; Majhail, Navneet S.

doi:10.1016/j.bbmt.2012.04.001

Cited by 74 publications

(59 citation statements)

References 29 publications

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“…on June 7, 2019. by guest www.bloodjournal.org From analyses,time horizons, and study methods, as has been reported by prior reviews of literature in this area. 55,56 Most studies have focused on the early costs after transplantation until 100 days or 1 year; cost studies beyond 1 year are rare. Investigators have shown that, similar to the clinical outcomes, the costs of procedures are influenced by patient-and disease-related factors, transplantationrelated factors, and external factors.…”

Section: Costs Of Hct 1549mentioning

confidence: 99%

Economics of hematopoietic cell transplantation

Khera

Zeliadt

Lee

2012

Blood

147

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Given the rapidly rising healthcare costs, it is important to understand the economic costs of hematopoietic cell transplantation (HCT), a procedure that is being used more frequently in the treatment of various hematologic disorders. Studies have reported a wide range of costs for HCT, from $36 000 to $88 000 (USD) for a single autologous transplantation for the initial hospitalization, to $200 000 (USD) or more for a myeloablative allogeneic procedure involving an unrelated donor. Common posttransplantation complications, such as infections and GVHD, have been shown to be significant cost drivers. Comparisons across studies are limited by differences in patient populations, cost ascertainment methods, and length of follow-up. This article summarizes the current state of knowledge about costs and cost-effectiveness of HCT, highlighting the challenges in conducting these studies and identifying important areas for future research. We discuss the need for more value-based assessments of HCT using high-quality approaches to measuring costs and outcomes so that potential future efforts to contain costs are well informed and appropriate.

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Section: Costs Of Hct 1549mentioning

confidence: 99%

Economics of hematopoietic cell transplantation

Khera

Zeliadt

Lee

2012

Blood

147

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“…5,6 Use of hematopoietic cell transplantation (HCT) as a treatment modality for many hematologic malignancies and some solid tumors has continued to grow, highlighting areas for further development and unmet need. [7][8][9][10] In this article, we review coordination problems unique to patients treated with HCT and identify pertinent stakeholders throughout the continuum of care. We describe the existing care coordination models and propose a framework for a coordination model for HCT using components from existing models to appropriately meet the complex needs of these patients.…”

Section: Introductionmentioning

confidence: 99%

Patient-centered care coordination in hematopoietic cell transplantation

Khera

Martín

Edsall³

et al. 2017

Blood Advances

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Hematopoietic cell transplantation (HCT) is an expensive, resource-intensive, and medically complicated modality for treatment of many hematologic disorders. A well-defined care coordination model through the continuum can help improve health care delivery for this high-cost, high-risk medical technology. In addition to the patients and their families, key stakeholders include not only the transplantation physicians and care teams (including subspecialists), but also hematologists/oncologists in private and academic-affiliated practices. Initial diagnosis and care, education regarding treatment options including HCT, timely referral to the transplantation center, and management of relapse and late medical or psychosocial complications after HCT are areas where the referring hematologists/ oncologists play a significant role. Payers and advocacy and community organizations are additional stakeholders in this complex care continuum. In this article, we describe a care coordination framework for patients treated with HCT within the context of coordination issues in care delivery and stakeholders involved. We outline the challenges in implementing such a model and describe a simplified approach at the level of the individual practice or center. This article also highlights ongoing efforts from physicians, medical directors, payer representatives, and patient advocates to help raise awareness of and develop access to adequate tools and resources for the oncology community to deliver well-coordinated care to patients treated with HCT. Lastly, we set the stage for policy changes around appropriate reimbursement to cover all aspects of care coordination and generate successful buy-in from all stakeholders.

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“…Although cost effectiveness of hematopoietic cell transplantation has been described, 33 such perspectives rely on single institution experiences. Identifying the origin of hospital charges in expensive procedures such as SCT is the first step in cost containment.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Outcomes of stem cell transplant patients with acute respiratory failure requiring mechanical ventilation in the United States

Allareddy

Roy

Rampa

et al. 2014

Bone Marrow Transplant

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SCT indications and procedures are increasing worldwide. We sought to estimate the prevalence of acute respiratory failure (ARF) of any cause in hospitalized SCT patients, and assess the impact of invasive mechanical ventilation (IMV) on outcomes. We hypothesize that duration of IMV in such patients is an independent predictor of higher mortality. We performed a retrospective analysis of the largest all-payer hospitalization data set in the United States, Nationwide In-patient Sample for years [2004][2005][2006][2007][2008][2009][2010]. Of the 101 462 SCT hospitalizations, 6074 (6%) developed ARF and were the final cohort. Type of SCT with ARF included autologous 1987 (32.7%), allogeneic 3467 (57.1%) and cord blood 655 (10.8%). Duration of IMV included o96 h (17.1%) and ⩾ 96 h (41.1%). Overall in-hospital mortality (IHM) was 50.6% (3075). Predictors of IHM were IMV o96 h (odds ratio = 3.42 (2.44-4.79), P o0.0001) or IMV ⩾ 96 h (OR = 4.61 (3.17-6.70), P o 0.0001). Type of SCT, comorbid burden, gender, hospital-teaching status/bed size or insurance did not influence IHM. IMV ⩾ 96 h was associated with higher hospital charges (mean $762 515, 95% estimate 0.3991 (0.3123-0.4859), increase of $304 474, P o 0.0001) and higher length of stay (mean 61.5 days, 95% estimate 0.2198 (0.1531-0.2866), increase of 13 days, P o 0.0001). In conclusion, ARF in hospitalized SCT patients is not an uncommon occurrence and is associated with 50% mortality. Duration of IMV (⩾96 h) was an independent predictor of higher mortality rates. Hospital resource utilization was significant.

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Costs and Cost-Effectiveness of Hematopoietic Cell Transplantation

Cited by 74 publications

References 29 publications

Economics of hematopoietic cell transplantation

Economics of hematopoietic cell transplantation

Patient-centered care coordination in hematopoietic cell transplantation

Outcomes of stem cell transplant patients with acute respiratory failure requiring mechanical ventilation in the United States

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