Real-World Economic Burden Associated with Transplantation-Related Complications

Abstract

Approximately 20,000 hematopoietic cell transplantation (HCT) procedures are performed annually in the United States. Real-world data on the costs associated with post-transplantation complications are limited. Patients with hematologic malignancies aged ≥18 years undergoing autologous HCT (auto-HCT) or allogeneic HCT (allo-HCT) between January 1, 2011, and June 30, 2014, were identified in the Truven Health MarketScan Research Databases. Patients were required to have 12 months of continuous medical and pharmacy enrollment before and after HCT; patients who experience inpatient death within 12 months post-HCT were also included. Patients with previous HCT were excluded. Potential HCT-related complications were identified if they had a medical claim with a diagnosis code for relapse; infection; cardiovascular, renal, neurologic, pulmonary, hepatic, or gastrointestinal disease; secondary malignancy; thrombotic microangiopathy; or posterior reversible encephalopathy syndrome within 1 year post-HCT. Healthcare costs attributable to these complications were evaluated by comparing total costs in HCT recipients with complications and those without complications. The MarketScan Research Databases were further linked to the Social Security Administration's Master Death File to obtain patient death events in a subset of patients. A total of 2672 HCT recipients were included in the analysis. The mean ± SD age of recipients was 54.5 ± 11.6 years, and the majority of recipients (63.6%) underwent auto-HCT. Complications were identified in 81% of auto-HCT recipients and in 95.5% of allo-HCT recipients. Most complications occurred within 180 days post-HCT. Compared with Auto-HCT recipients without complications, those with complications incurred $51,475 higher adjusted total costs (P < .01). Compared with allo-HCT recipients without complications, those with complications incurred $181,473 higher adjusted total costs (P < .01). Among the patients with mortality data, auto-HCT recipients with complications had a higher mortality rate (13.4% vs 5.7%, P < .01) and a lower probability of survival (P < .01) compared with those without complications. In allo-HCT recipients, however, the mortality rate and probability of survival were not significantly different between those with complications and those without complications. HCT recipients with complications were associated with considerable economic burden in terms of direct healthcare costs in a commercially insured population, and in the case of auto-HCT, a higher mortality rate was observed in those with complications.

Impact and safety of chimeric antigen receptor T-cell therapy in older, vulnerable patients with relapsed/refractory large B-cell lymphoma

“…Multi-dimensional geriatric assessment (GA) of comorbidity, function, mobility, nutrition, mood, and medication was prospectively collected prior to CAR T by a geriatrician or by an interdisciplinary clinical provider as previously described 4 . Specifically, the comorbidity burden was defined using the Deyo/Charlson Comorbidity Index (DCI/CCI) 5 . Functional limitation was defined by deficits in basic or instrumental activities of daily living (ADL/IADL) 4 .…”

Increased risk of cardio-cerebrovascular disease after hematopoietic cell transplantation in patients with previous history

“…A retrospective cohort study reported that the frequencies of CV complications within 12 months after auto-HCT and allo-HCT were 16.90%, and 27.30%, respectively. [ 20 ] Among the 18 patients who developed post-CCVD in our study, 88.90% (16/18) underwent allo-HCT and only 11.10% (2/18) underwent auto-HCT. This data indicates that allo-HCT leads to higher CV toxicity than auto-HCT, suggesting that post-CCVD is a strong predictor for transplant-associated toxicity on survival.…”

Cost-effectiveness analysis of defibrotide in the treatment of patients with severe veno-occlusive disease/sinusoidal obstructive syndrome with multiorgan dysfunction following hematopoietic cell transplantation in Spain

“…The cost-effectiveness ratios obtained were below the cost-effectiveness threshold of €30,000/QALY commonly used in Spain [32]. It should also be noted that the cost of defibrotide therapy, relative to the overall costs of transplantation and of managing HCT patients, especially those with post-HCT complications [33], is low. Indeed, it has been estimated that post-HCT VOD/SOS can increase hospital and ICU costs by up to threefold [34].…”