Economic evaluation of allogeneic bone marrow transplantation: a rudimentary model to generate estimates for the timely formulation of clinical policy.

Barr, Ronald D.; Furlong, William; Henwood, Jennifer; Feeny, David; Wegener, John; Walker, Irwin; Brain, M. C.

doi:10.1200/jco.1996.14.5.1413

Cited by 49 publications

(53 citation statements)

References 18 publications

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“…Few studies have so far reported costs of HLA-identical sibling SCT, [4][5][6][7][8][9] and only one study has been published on costs of unrelated voluntary SCT 3 for a narrowly defined patient group, chronic phase CML. We have not attempted to compare the absolute costs reported, as there are too many possible biases and discrepancies.…”

Section: Discussionmentioning

confidence: 99%

“…3 Published studies on the basis of real patient data estimating costs of SCT for adult leukaemia using HLAidentical sibling donors show wide variations and range from approximately US$ 20 000 to US$ 225 000. [4][5][6][7][8][9] The differences are probably due to different costing methodologies and varying follow-up durations. These also hamper valid comparison of results.…”

mentioning

confidence: 99%

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Cost analysis of HLA-identical sibling and voluntary unrelated allogeneic bone marrow and peripheral blood stem cell transplantation in adults with acute myelocytic leukaemia or acute lymphoblastic leukaemia

Agthoven

Verdonck

et al. 2002

Bone Marrow Transplant

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Summary:Allogeneic stem cell transplantation (SCT) is one of the most expensive medical procedures. However, only a few studies to date have addressed the costs of HLAidentical sibling transplantation and only one study has reported costs of unrelated transplantation. No recent cost analysis with a proper follow-up period and donor identification expenses is available on related or voluntary matched unrelated donor (MUD) SCT for adult AML or ALL. Therefore, we calculated direct medical (hospital) costs based on 97 adults who underwent HLA-identical sibling bone marrow transplantation (BMT) or peripheral blood stem cell transplantation (PBSCT), and patients who received a graft from a MUD between 1994 and 1999. The average costs per transplanted patient were 98 334 (BMT), 151 754 (MUD), and 98 977 (PBSCT), including donor identification expenses, 2 years follow-up and costs of patients who were not transplanted after they had been planned to receive an allograft. The majority of these costs was generated during the hospitalisation for graft infusion. For MUD transplants, nearly one-third of these costs was spent on the search for a suitable donor. For patients who were alive after 2 years, cumulative expenses were calculated to be 103 509 (BMT), 173 587 (MUD), and 105 906 (PBSCT).

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Cost analysis of HLA-identical sibling and voluntary unrelated allogeneic bone marrow and peripheral blood stem cell transplantation in adults with acute myelocytic leukaemia or acute lymphoblastic leukaemia

Agthoven

Verdonck

et al. 2002

Bone Marrow Transplant

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Section: Introductionmentioning

confidence: 99%

“…It is, however, a complex, resource-intense and costly procedure. [1][2][3][4] The cost of HSCT has been previously evaluated, mainly in the setting of HLA identical sibling 5 and matched unrelated donor transplants.The first studies on the cost-efficacy of HSCT compared allogeneic HSCT to chemotherapy in patients with acute leukemia. 7,8 Despite the high cost of HSCT, the results demonstrated the advantages of the procedure due to the impact on long-term survival adjusted to the quality of life.…”

mentioning

confidence: 99%

Cost-effectiveness and clinical outcomes of double versus single cord blood transplantation in adults with acute leukemia in France

Labopin¹,

Ruggeri²,

Gorin³

et al. 2013

Haematologica

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IntroductionAllogeneic stem cell transplantation (HSCT) is effective treatment for patients with various hematologic disorders. It is, however, a complex, resource-intense and costly procedure. [1][2][3][4] The cost of HSCT has been previously evaluated, mainly in the setting of HLA identical sibling 5 and matched unrelated donor transplants.The first studies on the cost-efficacy of HSCT compared allogeneic HSCT to chemotherapy in patients with acute leukemia. 7,8 Despite the high cost of HSCT, the results demonstrated the advantages of the procedure due to the impact on long-term survival adjusted to the quality of life. In the first published studies, the estimated costs for HSCT varied greatly (Online Supplementary Table S1) depending on the country in which they were performed, type of donor, transplant center procedures and year of transplantation. 5,7,[9][10][11] A more recent comparative study of autologous and allogeneic HSCT for patients transplanted for hematologic malignancies in the USA estimated a 100-day total cost of US$ 203,026 for allogeneic HSCT. 12 Unrelated donor cord blood transplantation (UCBT) has become a widely accepted transplant modality in the absence of an HLA-matched donor. [13][14][15][16] However, the delay of engraftment and the increased risk of graft failure remain problems in adults transplanted with a single cord blood unit. The possibility of using two cord blood units has extended the use of UCBT to patients for whom a single unit containing a minimum of 2.5x10 7 /kg total nucleated cells is not available. [17][18][19] Studies have been performed comparing outcomes after single (s) UCBT and double (d) UCBT,20 but, none focused on a homo- open-access paper. doi:10.3324/haematol.2013.092254 The online version of this article has a Supplementary Appendix. Manuscript received on May 27, 2013. Manuscript accepted on October 14, 2013 Double cord blood transplantation extends the use of cord blood to adults for whom a single unit is not available, but the procedure is limited by its cost. To evaluate outcomes and cost-effectiveness of double compared to single cord blood transplantation, we analyzed 134 transplants in adults with acute leukemia in first remission. Transplants were performed in France with reduced intensity or myeloablative conditioning regimens. Costs were estimated from donor search to 1 year after transplantation. A Markov decision analysis model was used to calculate qualityadjusted life-years and cost-effectiveness ratio within 4 years. The overall survival at 2 years after single and double cord blood transplants was 42% versus 62%, respectively (P=0.03), while the leukemia-free-survival was 33% versus 53%, respectively (P=0.03). The relapse rate was 21% after double transplants and 42% after a single transplant (P=0.006). No difference was observed for non-relapse mortality or chronic graft-versus-host-disease. The estimated costs up to 1 year after reduced intensity conditioning for single and double cord blood transplantation were € 165,253 and €191,...

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“…Despite the intensive research in the field and high cost of the procedure, there have been very few investigations and publications on the cost of HSCT. [3][4][5][6][7] We have previously reported the total costs over 5 years after HSCT in 93 patients transplanted in 1998 and 1999 at our unit. 8 We found that higher costs of HSCT were associated with acute leukaemia, G-CSF prophylaxis, hospital care as opposed to home care, myeloablative conditioning (MAC) as opposed to reduced-intensity conditioning (RIC) and major transplantrelated complications.…”

Section: Introductionmentioning

confidence: 99%

Increased costs after allogeneic haematopoietic SCT are associated with major complications and re-transplantation

Remberger

Alvin

et al. 2011

Bone Marrow Transplant

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We wanted to evaluate factors associated with high costs after allogeneic haematopoietic SCT (HSCT). We collected all in-patient and outpatient costs during the first year after HSCT over 5 years, from 2003 to 2007. Mean 1-year costs per patient were h141 493 (95% confidence interval (95% CI) ¼ 125 019-157 967). Patients treated with non-myeloablative conditioning (NMC) had reduced costs, but patients treated with reduced-intensity or myeloablative conditioning had similar 1-year costs. Multivariate analysis showed that increased 1-year costs were seen in post-transplant complications: rejection (relative hazard (RH) 1.24, Po0.001), acute GVHD of grades III-IV (1.31, Po0.001) and invasive fungal infection (1.15, P ¼ 0.02). In addition, increased costs were associated with retransplantation (1.21, P ¼ 0.001), mesenchymal stem-cell therapy (1.26, Po0.001), unrelated donor transplants (1.20, P ¼ 0.002) and the need for G-CSF treatment due to poor engraftment (1.12, P ¼ 0.047). In patients without any of these risk factors, mean 1-year costs were h84 773 (95% CI ¼ 71 145-98 400) (n ¼ 51). With three risk factors, the cost increased to h249 775 (95% CI ¼ 166 824-332 727) (n ¼ 14). To conclude, major complications increased the costs of HSCT. Unrelated donor transplants were more expensive than HLAidentical sibling transplants. Costs were reduced in patients treated with NMC.

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Economic evaluation of allogeneic bone marrow transplantation: a rudimentary model to generate estimates for the timely formulation of clinical policy.

Abstract: For AML (2CR), allogeneic BMT creates better outcomes than standard treatment, but is more costly. For ALL (1CR), both the costs and outcomes are similar for BMT and standard therapy. Quality adjustments made to life-years gained did not change these conclusions.

Cited by 49 publications

References 18 publications

Cost analysis of HLA-identical sibling and voluntary unrelated allogeneic bone marrow and peripheral blood stem cell transplantation in adults with acute myelocytic leukaemia or acute lymphoblastic leukaemia

Cost analysis of HLA-identical sibling and voluntary unrelated allogeneic bone marrow and peripheral blood stem cell transplantation in adults with acute myelocytic leukaemia or acute lymphoblastic leukaemia

Cost-effectiveness and clinical outcomes of double versus single cord blood transplantation in adults with acute leukemia in France

Increased costs after allogeneic haematopoietic SCT are associated with major complications and re-transplantation

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