title: Economic evaluation of allogeneic bone marrow transplantation: a rudimentary model to generate estimates for the timely formulation of clinical policy.
abstract: OBJECTIVE
  To provide an evidence-based approach to the formulation of clinical policy with respect to allogeneic bone marrow transplantation (BMT) that involves perceived trade offs between two major factors: costs and consequences. The report also highlights key informational deficiencies.
  
  
  METHODS
  Adults with acute myeloid leukemia (AML) in second complete remission (2CR) and those with acute lymphoblastic leukemia (ALL) in first complete remission (1CR) were assigned to BMT or control groups solely on the availability of a suitable donor. All hospital-borne costs were estimated, based on services used according to manual chart review, in four categories: diagnostic and therapeutic costs, professional fees, drug costs, and ward costs. Incremental costs and incremental life-years were calculated, and the quotient determined a cost per life-year gained by BMT for AML (2CR) and ALL (1CR).
  
  
  RESULTS
  The incremental cost (in 1992 Canadian dollars) per life-year gained by BMT (cost-effectiveness) for AML (2CR) was $29,200; and for ALL (1CR) it was minus $29,200.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Barr
authors.forename: W
authors.initials: W
authors.lastname: Furlong
authors.forename: J
authors.initials: J
authors.lastname: Henwood
authors.forename: D
authors.initials: D
authors.lastname: Feeny
authors.forename: J
authors.initials: J
authors.lastname: Wegener
authors.forename: I
authors.initials: I
authors.lastname: Walker
authors.forename: M
authors.initials: M
authors.lastname: Brain
mesh_terms: D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000191:economics*; D003362:Cost-Benefit Analysis; D006291:Health Policy; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000191:economics / Q000628:therapy*; D008017:Life Expectancy; D018803:Models, Economic; D009864:Ontario; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000191:economics / Q000628:therapy*; D016019:Survival Analysis