title: Costs of allogeneic hematopoietic cell transplantation with high-dose regimens.
abstract: To characterize the costs of allogeneic hematopoietic cell transplantation with high-dose regimens (HDCT), we analyzed clinical information and costs of 315 HDCT recipients during a 4-year study period beginning in 2000. Multivariate analyses were performed to identify pre- and/or post-HDCT factors predicting higher costs within the first year. Overall survival (OS) at 100 days and 1 year were 80% and 58%, respectively. The median cost and days of hospitalization were $102,574 in 2004 US dollars and 36 days in the hospital for 100 days, and $128,800 and 39 days in the hospital for 1 year. Early costs, defined as costs within the first 100 days, accounted for 84% of total costs within the first year. Inpatient costs comprise 94% of the early costs, but only 61% of the later costs defined as costs incurred between 101 days and 1 year. Of the pre-HDCT factors, unrelated donors and advanced disease risk were significantly associated with increased cost. When post-HDCT events were also considered, these pre-HDCT factors were no longer independently predictive of high cost. Instead, severe complications post-HDCT were associated with higher costs, increasing total costs $20,228 on average. If no complications occurred, the mean cost within the first year was $79,222. These results provide cost estimates for complicated and uncomplicated HDCT procedures, as well as costs for management of specific transplant complications.
authors.affiliation: Division of Medical Oncology, Dana-Farber Cancer Institute, and Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. akiko_saito@dfci.harvard.edu
authors.forename: Akiko M
authors.initials: AM
authors.lastname: Saito
authors.forename: Corey
authors.initials: C
authors.lastname: Cutler
authors.forename: David
authors.initials: D
authors.lastname: Zahrieh
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Soiffer
authors.forename: Vincent T
authors.initials: VT
authors.lastname: Ho
authors.forename: Edwin P
authors.initials: EP
authors.lastname: Alyea
authors.forename: John
authors.initials: J
authors.lastname: Koreth
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Antin
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Lee
mesh_terms: D000328:Adult; D003365:Costs and Cost Analysis; D003625:Data Collection; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics* / Q000379:methods* / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016019:Survival Analysis; D014184:Transplantation, Homologous; D016896:Treatment Outcome