title: Costs of allogeneic hematopoietic stem cell transplantation.
abstract: BACKGROUND
  This study aims to determine the total costs after allogeneic hematopoietic stem cell transplantation (ASCT) and factors associated with increases or decreases in costs.
  
  
  METHODS
  We collected all in- and outpatient costs during 5 years in 93 patients who had undergone ASCT in 1998 and 1999 at our unit. The inpatient costs included all those related to a patient from the first day of admission until discharge and then all costs of readmission in the Stockholm area.
  
  
  RESULTS
  The total median cost of five posttransplant years was 139,414 (52,095-345,640) euros (euros) or 167,296 US dollars (the rate of 1 euro is approximately 1.2 US dollars). The costs were highest during the first year-median inpatient and outpatient costs 100,650 euros and 13,066 euros, respectively. The total costs during the first year were higher in patients with acute graft-versus-host disease grades III-IV (relative hazards [RH] 1.35, P = 0.003), bacteremia (RH 1.33, P = 0.005), veno-occlusive disease of the liver (RH 1.32, P = 0.005), prophylaxis with granulocyte colony-stimulating factor (G-CSF; RH 1.31, P = 0.01), acute leukemia (RH 1.32, P = 0.008), and treatment in hospital instead of at home (RH 1.20, P < 0.07). During the early transplant period, a second transplantation (RH 1.28, P = 0.014) and hemorrhagic cystitis (HC; RH 1.24, P = 0.03) were also associated with higher costs. The total 5-year cost declined with longer survival rates (r = 0.4028, P < 0.001) and reduced intensity conditioning (RH 0.79, P=0.024).
  
  
  CONCLUSIONS
  Higher costs of ASCT were associated with retransplantation, acute leukemia, G-CSF prophylaxis, hospital care, myeloablative conditioning, and major transplant-related complications.
authors.affiliation: Center for Allogeneic Stem Cell Transplantation, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden. britt-marie.svahn@karolinska.se
authors.forename: Britt-Marie
authors.initials: BM
authors.lastname: Svahn
authors.forename: Ole
authors.initials: O
authors.lastname: Alvin
authors.forename: Olle
authors.initials: O
authors.lastname: Ringdén
authors.forename: Ann
authors.initials: A
authors.lastname: Gardulf
authors.forename: Mats
authors.initials: M
authors.lastname: Remberger
mesh_terms: D017281:Cost of Illness; D005500:Follow-Up Studies; D006801:Humans; D007239:Infections / Q000191:economics; D007297:Inpatients; D009369:Neoplasms / Q000191:economics / Q000628:therapy*; D010045:Outpatients; D033581:Stem Cell Transplantation / Q000191:economics* / Q000401:mortality; D016019:Survival Analysis; D013548:Sweden; D014184:Transplantation, Homologous