Costs of care and outcomes for high-dose therapy and autologous transplantation for lymphoid malignancies: results from the University of Nebraska 1987 through 1991.
OBJECTIVE
High-dose therapy with autologous stem-cell support has become common treatment for relapsed or refractory lymphomas. We conducted a study of 178 patients with Hodgkin's disease and 149 patients with non-Hodgkin's lymphoma who received high-dose therapy with stem-cell support. We evaluated the following: (1) whether improvements in outcomes over time found for surgical procedures were also true for a new nonsurgical procedure, autologous bone marrow and peripheral stem-cell transplantation; and (2) whether such a relationship, if it existed, applied to both clinical and economic outcomes.


RESULTS
Mortality rates for patients with Hodgkin's disease decreased from 20% in 1987 to 0% in 1991. For non-Hodgkin's lymphoma, the mortality rate decreased from 29% in 1987 to 4% in 1991. Multivariate analyses indicated that the number of previous transplants was the most important factor associated with survival and low-cost care. After controlling for differences in clinical factors, a logistic regression model predicted that patients with Hodgkin's disease had a 20% chance of dying after 30 cases and a 5% chance after 178 cases; patients with non-Hodgkin's disease had a 33% chance of dying after 14 cases and a 5% chance after 149 cases. For patients with Hodgkin's disease, the cost decreased at a rate of 10% per year from 1987 to 1991 (P = .001), while for patients with non-Hodgkin's lymphoma, the cost of transplants decreased at a rate of 8% per year.


CONCLUSIONS
Survival rates improved and costs of care decreased over time for patients who received high-dose therapy with stem-cell support. These changes are most likely related to improvements in supportive care technologies, better patient selection, and experience of the transplant team.
Bennett
C L
CL
Division of Health Services Research and Development, Lakeside Veterans Affairs Hospital, Chicago, IL 60611, USA.
Armitage
J L
JL
Armitage
G O
GO
Vose
J M
JM
Bierman
P J
PJ
Armitage
J O
JO
Anderson
J R
JR
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000191:economics; D016026:Bone Marrow Transplantation / Q000191:economics*; D017048:Health Care Costs; D018380:Hematopoietic Stem Cell Transplantation; D006689:Hodgkin Disease / Q000191:economics / Q000628:therapy; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008223:Lymphoma / Q000188:drug therapy / Q000191:economics* / Q000401:mortality / Q000628:therapy; D008228:Lymphoma, Non-Hodgkin / Q000191:economics / Q000628:therapy; D015999:Multivariate Analysis; D011379:Prognosis; D015996:Survival Rate; D014182:Transplantation, Autologous