Costs of pediatric allogeneic hematopoietic-cell transplantation.
BACKGROUND
Allogeneic hematopoietic-cell transplantation (HCT), although curative for some high-risk diseases, is a complex and costly procedure. The costs of transplantation among children have not been described previously.


METHODS
We compared the costs of HCT within the first 100-days among children who received myeloablative HCT from either a matched related donor (MRD, N = 27), matched unrelated donor (MUD, N = 28) or unrelated umbilical cord blood (UCB, N = 91). We also conducted analyses to describe predictors of higher costs of transplantation.


RESULTS
The 100-day probabilities of overall survival were 96%, 96% and 87% for MRD, MUD and UCB, respectively. The mean cost per day survived (excluding costs of graft acquisition) was $3,446 (standard deviation (SD), $851) for MRD, $4,050 (SD, $1,194) for MUD and $4,522 (SD, $2,053) for UCB recipients. The costs of MUD and UCB HCT remained similar when costs of graft acquisition were considered within total costs of transplantation. In multivariable analysis, adjusting for important patient, disease, and transplant related characteristics, factors associated with higher costs within the first 100-days were HCT using MUD or UCB, Lansky score <90 at transplant, graft failure, need for dialysis, need for mechanical ventilation and occurrence of hepatic veno-occlusive disease.


CONCLUSIONS
Within the first 100-days, the costs of MUD and UCB HCT are similar, while MRD HCT is less costly. These costs are primarily driven by severe post-transplant complications and graft failure.
Majhail
Navneet S
NS
Adult Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN 55455, USA. majha001@umn.edu
Mothukuri
Jaya M
JM
Macmillan
Margaret L
ML
Verneris
Michael R
MR
Orchard
Paul J
PJ
Wagner
John E
JE
Weisdorf
Daniel J
DJ
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D046148:Donor Selection; D005260:Female; D005312:Fetal Blood; D006085:Graft Survival; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics*; D006650:Histocompatibility Testing; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D014019:Tissue Donors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome
Biol Blood Marrow Transplant. 2009 May;15(5):564-73
19361748
J Clin Oncol. 2000 Jan;18(1):64-71
10623694
Blood. 1998 Oct 15;92(8):2725-9
9763556
Bone Marrow Transplant. 1999 Sep;24(5):555-60
10482942
Biol Blood Marrow Transplant. 2002;8(7):387-94
12171485
Bone Marrow Transplant. 2007 Aug;40(3):209-17
17563734
Biol Blood Marrow Transplant. 2007 Oct;13(10):1145-52
17889350
J Clin Oncol. 2008 May 1;26(13):2162-70
18378566
Br J Haematol. 2000 Apr;109(1):121-9
10848791
Bone Marrow Transplant. 2002 Aug;30(4):243-51
12203141
Biol Blood Marrow Transplant. 2008 Feb;14(2):197-207
18215780
Pediatr Blood Cancer. 2006 May 1;46(5):630-6
16078221
Blood. 2009 Mar 12;113(11):2410-5
18997171
Curr Opin Immunol. 2006 Oct;18(5):571-5
16895752
Biol Blood Marrow Transplant. 2008 Mar;14(3):282-9
18275894
Biol Blood Marrow Transplant. 2008 Jun;14(6):685-92
18489994
Blood. 1998 Dec 1;92(11):4047-52
9834208
Blood. 2002 Sep 1;100(5):1611-8
12176879
Transplantation. 2004 Jun 27;77(12):1854-8
15223903
Biol Blood Marrow Transplant. 2008 Nov;14(11):1231-8
18940677