The cost-effectiveness of stem cell transplantations from unrelated donors in adult patients with acute leukemia.
OBJECTIVE
Hematopoietic stem cell transplantation is an accepted treatment of hematological malignancies, but the cost-effectiveness of this technology has not been fully explored. This study aims to assess the cost-effectiveness of stem cell transplantation from either cord blood or bone marrow/peripheral blood compared with no transplantation in adult patients with acute leukemias not expected to be cured with chemotherapy.


METHODS
A systematic review was performed to estimate the efficacy of unrelated cord blood and bone marrow/peripheral blood stem cells (BM/PBSC) transplantations in adults with acute leukemia. A Markov decision analysis model using Monte Carlo simulations was used to calculate the incremental cost-effectiveness ratio (ICER) and 95% confidence intervals (CIs).


RESULTS
The estimated cumulative survival at 1 and 10 years were 27.9% and 14%, respectively, for cord blood recipients and 47% and 17.7%, respectively, for BM/PBSC recipients. Using conservative assumptions, the cost per life-year gained compared with no transplantation was US 16,346 dollars (95% CI 8695 dollars, 38,006 dollars) for BM/PBSC transplantation and US 34,360 dollars (95% CI 23,101 dollars, 89,417 dollars) for cord blood transplantation.


CONCLUSIONS
Although both types of stem cell transplantations are associated with a high short-term mortality and high cost, the cumulative gains in life-years of survivors can be substantial, resulting in ICERs compared with no transplantation that are usually considered acceptable. However there is less certainty about this conclusion with cord blood transplantation.
Costa
Vania
V
Technology Assessment Unit, McGill University Health Centre, Montreal, QC, Canada.
McGregor
Maurice
M
Laneuville
Pierre
P
Brophy
James M
JM
D000293:Adolescent; D003362:Cost-Benefit Analysis; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics*; D006801:Humans; D007938:Leukemia / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011792:Quebec