title: Lower costs associated with hematopoietic cell transplantation using reduced intensity vs high-dose regimens for hematological malignancy.
abstract: We compared inpatient and outpatient costs alongside clinical outcomes associated with hematopoietic cell transplantation between 2000 and 2003 with high-dose regimens (HDCT, n=185) and with reduced intensity regimens (RICT, n=90) from human leukocyte antigen (HLA)-matched donors for patients with hematological malignancies. With a comparable median follow-up of 3 years, long-term clinical outcomes, including cumulative incidence of chronic graft-vs-host disease, disease-free survival and overall survival, were similar between the two groups. In the univariate analysis, median costs for the first 100 days ($104,380 vs $42,149) and 1 year ($128,253 vs $80,499) in the HDCT group were higher than those in the RICT group. Median days of hospitalization are also higher for HDCT recipients (39 vs 21), although the number of outpatient clinic visits for HDCT recipients were fewer compared to that for RICT recipients (16 vs 25) during the first year. Adjusting for patient characteristics, RICT recipients had approximately 16 fewer days of hospitalization and cost $53,030 less than HDCT recipients within the first year after transplantation. Our data suggest that substantially lower costs and fewer days of hospitalization within the first year after RICT procedures can be obtained with no compromise of long-term clinical outcomes compared to HDCT procedures.
authors.affiliation: Division of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA. akiko_saito@dfci.harvard.edu
authors.forename: A M
authors.initials: AM
authors.lastname: Saito
authors.forename: D
authors.initials: D
authors.lastname: Zahrieh
authors.forename: C
authors.initials: C
authors.lastname: Cutler
authors.forename: V T
authors.initials: VT
authors.lastname: Ho
authors.forename: J H
authors.initials: JH
authors.lastname: Antin
authors.forename: R J
authors.initials: RJ
authors.lastname: Soiffer
authors.forename: E P
authors.initials: EP
authors.lastname: Alyea
authors.forename: S J
authors.initials: SJ
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics*; D002648:Child; D003365:Costs and Cost Analysis; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000191:economics / Q000401:mortality; D019337:Hematologic Neoplasms / Q000191:economics* / Q000401:mortality / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics* / Q000401:mortality; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000191:economics*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate