title: Economic analysis of unrelated allogeneic bone marrow transplantation: results from the randomized clinical trial of T-cell depletion vs unmanipulated grafts for the prevention of graft-versus-host disease.
abstract: Unrelated-donor marrow transplantation is a potential option for transplant candidates lacking a compatible related donor. The T-cell Depletion Study compared the 3-year disease-free survival for patients receiving T-cell-depleted (TCD) donor marrow (n = 203) vs unmanipulated donor marrow with methotrexate and cyclosporine (M/C) (n = 207). Hospital costs during index admission were documented with billing data, while hospital costs during subsequent 6-month follow-up were estimated from case report forms. Patients with index admission billing were included in the analysis (TCD = 119, M/C = 127). Total hospital length of stay (LOS) was similar across groups, with medians 47.0 days for TCD and 52.0 days for M/C (P = 0.72). Total hospital costs were comparable, 145,115 dollars vs 141,981 dollars (P = 0.63) for TCD and M/C, respectively. However, controlling for site and patient characteristics, TCD was associated with a 12.1% reduction in LOS for the index admission (95% CI -19.4%, -4.3%). Independent of treatment, HLA matching (6/6) was associated with an 8.6% (95% CI -17.4%, +1.2%) reduction in the index admission LOS, while cost was lower by 15.8% (95% CI -26.7%, -3.3%). Treatment costs were similar for TCD and M/C study groups. Savings on reduced cost for treating acute graft-versus-host disease were likely offset by increase in serious infections in the TCD arm.
authors.affiliation: MEDTAP International Incorporated, Center of Health Economics, Bethesda, MD 20814, USA. deLissovoy@medtap.com
authors.forename: G
authors.initials: G
authors.lastname: de Lissovoy
authors.forename: D
authors.initials: D
authors.lastname: Hurd
authors.forename: S
authors.initials: S
authors.lastname: Carter
authors.forename: P
authors.initials: P
authors.lastname: Beatty
authors.forename: M
authors.initials: M
authors.lastname: Ewell
authors.forename: J
authors.initials: J
authors.lastname: Henslee-Downey
authors.forename: N
authors.initials: N
authors.lastname: Kernan
authors.forename: S
authors.initials: S
authors.lastname: Yanovich
authors.forename: D
authors.initials: D
authors.lastname: Weisdorf
mesh_terms: D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000191:economics*; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D005260:Female; D006086:Graft vs Host Disease / Q000191:economics; D006801:Humans; D007223:Infant; D007239:Infections; D007902:Length of Stay; D008212:Lymphocyte Depletion / Q000009:adverse effects / Q000191:economics*; D008297:Male; D008875:Middle Aged; D014184:Transplantation, Homologous