Predicting the costs of allogeneic sibling stem-cell transplantation: results from a prospective, multicenter, French study.
BACKGROUND
Allogeneic hematopoietic stem-cell transplantation is a widely used, cost-intensive procedure. Our purpose was to estimate costs and determine cost predictors.


METHODS
We used data from a prospective French study comparing four doses of immunoglobulins. Resource use of hematopoietic stem-cell transplant recipients during the first 6 months posttransplant, both inpatient and ambulatory costs, in 85 patients from five centers were collected prospectively and costed. Baseline data and clinical events were retrieved. Protocol-driven costs were excluded. Multivariable analysis evaluated the association between costs and patient's pretransplant status and transplant-related complications. Because of the absence of differences in outcome among the four randomization groups, cost data for all patients were pooled.


RESULTS
Total costs per patient were the following: mean 76,237 Euros; standard deviation 32,565 Euros; median 69,516 Euros; range 183,758 to 14,761Euros. The major cost driver was hospital days. No association was found between costs and baseline status. The "predictors" of higher costs (adding an average 20,000 Euros/patient) were the occurrence of transplant-related complications: graft-versus-host disease and repeated infections that were unpredictable before transplant in this homogeneous group of patients.


CONCLUSIONS
Our data highlight the discrepancy between the Diagnosis Related Group prospective payment system and actual costs. The actual cost of geno-identical stem-cell transplantation results from posttransplant complications that cannot be predicted prospectively and require ex post cost adjustment.
Espérou
Hélène
H
Hematology Department, St. Louis Hospital, Assistance Publique-Hôpitaux de Paris (AP/HP), 1 Avenue Claude Vellefaux, 75475 Paris Cedex 10, France. helene.esperou@chu-stlouis.fr
Brunot
Alain
A
Roudot-Thoraval
Françoise
F
Buzyn
Agnes
A
Dhedin
Nathalie
N
Rio
Bernard
B
Chevret
Sylvie
S
Bassompierre
François
F
Gluckman
Eliane
E
Cordonnier
Catherine
C
Durand-Zaleski
Isabelle
I
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D002648:Child; D002908:Chronic Disease; D003365:Costs and Cost Analysis; D005260:Female; D005602:France; D006086:Graft vs Host Disease / Q000191:economics / Q000453:epidemiology; D019650:Hematopoietic Stem Cell Mobilization / Q000191:economics; D006801:Humans; D007239:Infections / Q000191:economics / Q000453:epidemiology; D007938:Leukemia / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010919:Placebos; D033581:Stem Cell Transplantation / Q000009:adverse effects / Q000191:economics*; D014184:Transplantation, Homologous / Q000191:economics; D014916:Whole-Body Irradiation / Q000191:economics
D010919:Placebos