Costs of Second Allogeneic Hematopoietic Cell Transplantation

Khera, Nandita; Storer, Barry E.; Sandmaier, Brenda M.; Chapko, Michael K.; Lee, Stephanie J.

doi:10.1097/tp.0b013e318294caf1

Cited by 6 publications

(5 citation statements)

References 27 publications

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“…The cost‐effectiveness of a second HSCT has been previously described with an acceptable cost profile when compared with chemotherapy in relapsed leukemia patients 32 . We previously described the cost affordability and the efficacy of our outpatient transplant program with outcomes comparable to those reported from centers in high‐income countries 16,17 …”

Section: Discussionmentioning

confidence: 76%

Outcomes of second hematopoietic stem cell transplantation using reduced‐intensity conditioning in an outpatient setting

Jaime‐Pérez

Picón‐Galindo

Herrera‐Garza

et al. 2020

Hematological Oncology

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Relapse and graft failure after autologous (auto) or allogeneic (allo) hematopoietic stem cell transplantation (HSCT) are serious and frequently fatal events. A second HSCT can be a life‐saving alternative, however, information on the results of such intervention in an outpatient setting is limited. Outpatient second hematoprogenitors transplant after reduced‐intensity conditioning (RIC) at a single academic center was analyzed. Twenty‐seven consecutive adults who received an allo‐HSCT after an initial auto‐ or allo‐HSCT from 2006 to 2019 were included. Data were compared using the χ2‐test. Survival analysis using Kaplan–Meier and Cox proportional hazard models was performed; cumulative incidence estimation of transplant‐related mortality (TRM) was assessed. Hodgkin lymphoma was the most frequent diagnosis for the group with a first auto‐HSCT with 5/12 (41.7%) cases, and acute myeloid leukemia for those with a first allo‐HSCT with 6/15 (40%). One‐year overall survival and disease‐free survival (DFS) was 66.7% (95% CI 27.2–88.2) and 59% (95% CI 16–86) for 12 patients with a first auto‐HSCT; and for 15 patients with a first allo‐HSCT, it was 43.3% (95% CI 17.9–66.5) and 36% (95% CI 13.2–59.9), respectively. Eight (29.6%) patients died of TRM and the cumulative incidence of TRM at 1 year was 22% (95% CI 8.6–39.27). Chronic graft‐versus‐host disease and late (>10 months) second transplantation were protective factors for longer survival. Neutropenic fever was more common in the group with a first allo‐HSCT (p = 0.01). In conclusion, outpatient second allo‐HSCT using RIC after auto‐ or allografting failure or relapse is feasible and offers a reasonable alternative for patients with severe life‐threatening hematological diseases.

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Section: Discussionmentioning

confidence: 76%

Outcomes of second hematopoietic stem cell transplantation using reduced‐intensity conditioning in an outpatient setting

Jaime‐Pérez

Picón‐Galindo

Herrera‐Garza

et al. 2020

Hematological Oncology

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“…26–31 Few studies have compared the costs of HCT to other treatments for AML, such as chemotherapy alone, 32 which limits the usefulness of their results for payers and policy makers who are interested in the utilization and cost impact of HCT for the treatment of AML. Administrative claims data are generally drawn from large populations, which is beneficial for the study of rare diseases or treatments.…”

Section: Case Study: Assessing Costs In the First Year After Diagnosimentioning

confidence: 99%

Administrative Claims Data for Economic Analyses in Hematopoietic Cell Transplantation: Challenges and Opportunities

Preussler

Mau

Majhail

et al. 2016

Biology of Blood and Marrow Transplantation

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There is an increasing need for the development of approaches to measure quality, costs and resource utilization patterns among allogeneic hematopoietic cell transplant (HCT) patients. Administrative claims data provide an opportunity to examine service utilization and costs, particularly from the payer’s perspective. However, because administrative claims data are primarily designed for reimbursement purposes, challenges arise when using it for research. We use a case study with data derived from the 2007–2011 Truven Health MarketScan Research database to discuss opportunities and challenges for the use of administrative claims data to examine the costs and service utilization of allogeneic HCT and chemotherapy alone for patients with acute myeloid leukemia (AML). Starting with a cohort of 29,915 potentially eligible patients with a diagnosis of AML, we were able to identify 211 patients treated with HCT and 774 treated with chemotherapy only where we were sufficiently confident of the diagnosis and treatment path to allow analysis. Administrative claims data provide an avenue to meet the need for health care costs, resource utilization, and outcome information. However, when using these data, a balance between clinical knowledge and applied methods is critical to identifying a valid study cohort and accurate measures of costs and resource utilization.

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“…All patients who had a prior HCT (autologous or allogeneic) were excluded because we have recently reported in a separate paper information about cost profiles of second allogeneic HCT following a prior autologous or allogeneic transplant in which 70% of the study population received RIC regimens [12]. Patients who had a subsequent HCT in the study time frame of 100 days for FHCRC (n 5 4) or 2 years for DF/BWCC (n 5 24) had associated costs included in the analysis.…”

Section: Patientsmentioning

confidence: 99%

“…Patients (n 5 484) who underwent a first allogeneic HCTusing RIC from January 1, 2008, through June 30, 2010, at the Fred Hutchinson Cancer Research Center (FHCRC; n 5 147) and the Dana-Farber/Brigham and Women's Cancer Center (DF/ BWCC; n 5 337) were included. All patients who had a prior HCT (autologous or allogeneic) were excluded because we have recently reported in a separate paper information about cost profiles of second allogeneic HCT following a prior autologous or allogeneic transplant in which 70% of the study population received RIC regimens [12]. Patients who had a subsequent HCT in the study time frame of 100 days for FHCRC (n 5 4) or 2 years for DF/BWCC (n 5 24) had associated costs included in the analysis.…”

Section: Patientsmentioning

confidence: 99%

Costs of Allogeneic Hematopoietic Cell Transplantation Using Reduced Intensity Conditioning Regimens

et al. 2014

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Reduced intensity conditioning (RIC) regimens have allowed older patients and those with comorbidities to receive hematopoietic cell transplantation (HCT). We analyzed medical costs from the beginning of conditioning to 100 days after HCT for 484 patients and up to 2 years for 311 patients who underwent a RIC HCT at two institutions from January 2008 to December 2010. Multiple linear regression was used to analyze the association between clinical variables, center effect, and costs. Patient and transplant characteristics were comparable between the sites, although differences were seen in pretransplant performance scores. 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. Grade II-IV acute graftversus-host disease (GVHD) was associated with higher costs. The overall short-term costs between the two institutions were comparable when adjusted for clinical variables (p 5 .43). Late costs between 100 days and 2 years after HCT were available for one cohort (n 5 311); median costs during this period were $39,000 and accounted for 39% of costs during the first 2 years. Late costs were not associated with any pretransplant variables, but were higher with extensive chronic GVHD and death. After adjustment for clinical characteristics, the overall costs of the RIC transplants were similar between the two institutions despite different management approaches (inpatient vs. outpatient conditioning) and accounting methodologies. Use of unrelated/ alternative donors, transplant for diseases other than lymphoma or myeloma, and acute GVHD were predictors for higher early costs, and extensive chronic GVHD and death were associated with higher late costs. The Oncologist 2014; 19:639-644Implications for Practice: This study from two large centers describes the profile and predictors of costs of reduced intensity conditioning (RIC) hematopoietic cell transplantation. Results indicate comparable costs between two centers with different practice patterns. Identification of optimum donors with favorable cost-benefit ratio and interventions to prevent complications such as graft-versus-host disease may yield clinical and financial benefits. A commitment to lowering costs while preserving quality of care is essential in the current environment, especially for RIC transplants. These transplants are done mainly for the older population, a majority of whom may be prone to insufficient coverage and declining reimbursements by Medicare.The study also underscores the need for collection of resource utilization data in a prospective fashion with clinical studies.

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Costs of Second Allogeneic Hematopoietic Cell Transplantation

Cited by 6 publications

References 27 publications

Outcomes of second hematopoietic stem cell transplantation using reduced‐intensity conditioning in an outpatient setting

Outcomes of second hematopoietic stem cell transplantation using reduced‐intensity conditioning in an outpatient setting

Administrative Claims Data for Economic Analyses in Hematopoietic Cell Transplantation: Challenges and Opportunities

Costs of Allogeneic Hematopoietic Cell Transplantation Using Reduced Intensity Conditioning Regimens

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