Hematopoietic stem cell transplantation in Switzerland: a comprehensive quality control report on centre effect.
OBJECTIVE
Interest groups advocate centre-specific outcome data as a useful tool for patients in choosing a hospital for their treatment and for decision-making by politicians and the insurance industry. Haematopoietic stem cell transplantation (HSCT) requires significant infrastructure and represents a cost-intensive procedure. It therefore qualifies as a prime target for such a policy.


METHODS
We made use of the comprehensive database of the Swiss Blood Stem Cells Transplant Group (SBST) to evaluate potential use of mortality rates. Nine institutions reported a total of 4717 HSCT - 1427 allogeneic (30.3%), 3290 autologous (69.7%) - in 3808 patients between the years 1997 and 2008. Data were analysed for survival- and transplantation-related mortality (TRM) at day 100 and at 5 years.


RESULTS
The data showed marked and significant differences between centres in unadjusted analyses. These differences were absent or marginal when the results were adjusted for disease, year of transplant and the EBMT risk score (a score incorporating patient age, disease stage, time interval between diagnosis and transplantation, and, for allogeneic transplants, donor type and donor-recipient gender combination) in a multivariable analysis.


CONCLUSIONS
These data indicate comparable quality among centres in Switzerland. They show that comparison of crude centre-specific outcome data without adjustment for the patient mix may be misleading. Mandatory data collection and systematic review of all cases within a comprehensive quality management system might, in contrast, serve as a model to ascertain the quality of other cost-intensive therapies in Switzerland.
Passweg
Jakob
J
Haematology, University Hospital, Geneva (HUG), Switzerland. info@swissbloodstemcells.ch
Baldomero
Helen
H
Stern
Martin
M
Bargetzi
Mario
M
Ghielmini
Michele
M
Leibundgut
Kurt
K
Duchosal
Michel
M
Hess
Urs
U
Seger
Reinhard
R
Buhrfeind
Eva
E
Schanz
Urs
U
Gratwohl
Alois
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality* / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data*; D012042:Registries / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013557:Switzerland; D016896:Treatment Outcome; D055815:Young Adult