Costs of allogeneic hematopoietic cell transplantation using reduced intensity conditioning regimens.

Abstract

7034 Background: Reduced intensity (RIC) conditioning regimens have allowed older patients and those with comorbidities to receive hematopoietic cell transplantation (HCT). Methods: We analyzed medical costs from the beginning of conditioning to 100 days after HCT for 484 patients who underwent a RIC allogeneic HCT at Fred Hutchinson Cancer Research Center (FHCRC; n=147) and Dana Farber Cancer Institute (DFCI; n=337) from 1/2008 to 12/2010. Costs up to 2 years after HCT were analyzed for DFCI (n=311) as most patients receive their post-transplant care there. Multiple linear regression was used to analyze the association between clinical variables and costs. Results: Disease distribution and transplant characteristics were comparable between the two sites, though significant differences were seen in age distribution (88% FHCRC patients ≥ 50 years vs. 80% at DFCI, p=0.04) and pre-transplant performance scores (63% patients with Karnofsky score≥ 90 at FHCRC vs. 47% at DFCI; p=0.006). Median costs for first 100 days in 2010 $ at FHCRC and DFCI were $129 000 (range 31,000-352,000) and $96,000 (3,000-614,000) respectively, p=0.0002, but differences were not significant in multivariate analysis. Inpatient costs accounted for 42% of early costs at FHCRC and 87% at DFCI.Significant predictors for early costs included a diagnosis of lymphoma/ myeloma (17% decrease in costs; p=0.01), donors other than matched related (50 -100% increase; p<0.001), relapse (17% increase, p=0.04) and ≥ grade II acute GVHD (37% increase; p<0.001). Median costs between d100 and 2 years were $39,000 (0-976,000) at DFCI. 39% of the 2 year costs occurred after first 100 days. There was no association of late costs with pre-transplant variables, and only death was associated with higher costs (138% increase; p=0.005). Conclusions: After adjustment for pre and post HCT variables, the overall costs of the RIC allogeneic transplants were similar between the two institutions despite different management approaches (inpatient vs. outpatient conditioning) and accounting methodologies. Use of unrelated/ alternative donors, relapse and acute GVHD were predictors for higher early costs while only death was associated with higher late costs.

Cost Structure and Clinical Outcome of a Stem Cell Transplantation Program in a Developing Country: The Experience in Northeast Mexico

“…Costs related to hospitalization were the major contributors across the studies, and cost associated with initial hospitalization for HSCT was the main driver of total cost in the first 100 days post-transplantation [35]; medical staff costs, room and board, pharmacy, laboratory services, radiology, and blood products were the major cost contributors [36,37]. Recently, in a study of HSCT with RIC at 2 institutions, it was found that significant predictors for lower costs for the first 100 days included a diagnosis of lymphoma/myeloma and use of human leukocyte antigen-matched related donors, whereas grade II-IV acute GVHD was associated with higher costs [38].…”

Cost‐effectiveness analysis of consolidation with brentuximab vedotin for high‐risk Hodgkin lymphoma after autologous stem cell transplantation

“…24,29,30 Costs Baseline direct medical costs were derived from the 2016 Medicare fee schedule and the medical literature (Table 2). [36][37][38][39][40][41] Costs were converted into 2016 US dollars using the Medical Care component of the Consumer Price Index. Consistent with the Medicare pricing policy, we used 106% of the manufacturer's 2016 average sales price for drug costs.…”

“…5 Arai 2013, 31 Kaloyannidis 2012, 32 used in previous studies. [38][39][40] The cost of monitoring included office visits and routine laboratory tests. Endof-life health care costs were estimated from published data on the cost of care in the last year of life for patients with cancer compared with the general Medicare population.…”

“…36,37 Utilities Baseline clinical utilities for various health states were based on values used in previous studies and the published literature (Table 3). 40,45,46 In particular, results from the AETHERA trial's companion quality-of-life study informed our clinical utilities in the post-ASCT setting. 45 Individuals enrolled in AETHERA completed the Euro-Qol Five-Dimensions Questionnaire (EQ-5D) every 3 months for the first 2 years on study, and the published results displayed scores by treatment arm (BV consolidation vs placebo) and disease status (ongoing remission vs progressive disease).…”

“…Results of the baseline cost-effectiveness analysis are summarized in 40 Ramsey 2015, 45 40 Ramsey 2015, 45 40 Ramsey 2015, 45 Swinburn 2015 46 Abbreviations: BV, brentuximab vedotin; QALY, quality-adjusted life-years. consolidation therapy was associated with an improvement of 1.07 QALYs compared with active surveillance.…”