Randomized study of early hospital discharge following autologous blood SCT: medical outcomes and hospital costs

Abstract

We report the first randomized study comparing early hospital discharge with standard hospital-based follow-up after high-dose chemotherapy (HDCT) and PBSCT. Patients aged 18-65 years, with an indication of PBSCT for non-leukemic malignant diseases were randomly assigned between two arms. Arm A consisted of early hospital discharge (HDCT during hospitalization, discharge at day 0, home stay with a caregiver, outpatient clinic follow-up). In arm B patients were followed up as inpatients. In total 131 patients were analyzed (66 in arm A and 65 in arm B). Patient characteristics and hematological reconstitution were comparable between the two groups. In arm A, 26 patients were actually discharged early. Patients in group A spent fewer days in hospital (11 vs 12 days, P ¼ 0.006). This strategy resulted in a 6% mean cost reduction per patient when compared with the conventional hospital-based group. The early discharge approach within the French health system, while safe and feasible, is highly dependent on social criteria (caregiver availability and home to hospital distance). It is almost always associated with conventional hospital readmission during the aplasia phase, and limits cost savings when considering the whole population of patients benefiting from HDCT in routine clinical practice.

Autologous hematopoietic progenitor cell transplantation for multiple myeloma through an outpatient program

“…Nevertheless, currently the use of erythorpietin or amifostine remains unclear whether in the inpatient or outpatient setting. Recently, Faucher et al [73] reported the first randomized study comparing EDM with standard inpatient AHPCT on a cohort of 131 patients with non-leukemic malignant diseases. In both arms A and B, HDC and stem cell infusion occurred during the hospital stay.…”

“…The introduction of their mixed inpatient-outpatient transplant program allowed cost savings up to 1672 Euros/patient without any negative impact on patient's outcome. In a French randomized study [73], shifting from inpatient care to early discharge programs allowed cost savings up to 19% in a group of patients who were actually discharged early. However, considering all randomized patients, the program showed a mean cost per patient only 6% inferior as compared with that of the traditional inpatient group.…”

Italian consensus conference for the outpatient autologous stem cell transplantation management in multiple myeloma

“…21 In this study, HDM was used as conditioning in only 30% of the patients, and the study population was extremely heterogeneous.…”

“…7-9 The significant increase in the waiting lists generated concerns about the appropriate use of health care resources and, over the past years, some studies have investigated the safety, efficacy and potential cost advantages of reducing hospital stay for patients undergoing ASCT. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] The ease of administering HDM, the relatively low extra-hematological toxicity and the short period of neutropenia 5,6 make MM patients ideal candidates for outpatient ASCT programs. Standardization of criteria for the outpatient ASCT policy is a relevant goal of the Italian hematology and transplant community and may facilitate comparison of retrospective and prospective data.…”

Semi-ambulatory autologous peripheral blood SCT in 79 patients with multiple myeloma

“…We read with interest the paper of Faucher et al 1 dealing with a randomized prospective study of early discharge following autologous peripheral SCT (PBSCT).…”