title: Increased costs after allogeneic haematopoietic SCT are associated with major complications and re-transplantation.
abstract: We wanted to evaluate factors associated with high costs after allogeneic haematopoietic SCT (HSCT). We collected all in-patient and outpatient costs during the first year after HSCT over 5 years, from 2003 to 2007. Mean 1-year costs per patient were \[euro]141,493 (95% confidence interval (95% CI)=125,019-157,967). Patients treated with non-myeloablative conditioning (NMC) had reduced costs, but patients treated with reduced-intensity or myeloablative conditioning had similar 1-year costs. Multivariate analysis showed that increased 1-year costs were seen in post-transplant complications: rejection (relative hazard (RH) 1.24, P<0.001), acute GVHD of grades III-IV (1.31, P<0.001) and invasive fungal infection (1.15, P=0.02). In addition, increased costs were associated with re-transplantation (1.21, P=0.001), mesenchymal stem-cell therapy (1.26, P<0.001), unrelated donor transplants (1.20, P=0.002) and the need for G-CSF treatment due to poor engraftment (1.12, P=0.047). In patients without any of these risk factors, mean 1-year costs were \[euro]84,773 (95% CI=71,145-98,400) (n=51). With three risk factors, the cost increased to \[euro]249,775 (95% CI=166,824-332,727) (n=14). To conclude, major complications increased the costs of HSCT. Unrelated donor transplants were more expensive than HLA-identical sibling transplants. Costs were reduced in patients treated with NMC.
authors.affiliation: Centre for Allogeneic Stem Cell Transplantation, Karolinska Institutet and Karolinska University Hospital Huddinge, Stockholm, Sweden. Britt-Marie.Svahn@karolinska.se
authors.forename: B-M
authors.initials: BM
authors.lastname: Svahn
authors.forename: M
authors.initials: M
authors.lastname: Remberger
authors.forename: O
authors.initials: O
authors.lastname: Alvin
authors.forename: H
authors.initials: H
authors.lastname: Karlsson
authors.forename: O
authors.initials: O
authors.lastname: Ringdén
mesh_terms: D003365:Costs and Cost Analysis; D006084:Graft Rejection / Q000191:economics; D006086:Graft vs Host Disease / Q000191:economics; D016179:Granulocyte Colony-Stimulating Factor / Q000191:economics / Q000627:therapeutic use; D006680:HLA Antigens / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000191:economics*; D006504:Hepatic Veno-Occlusive Disease / Q000191:economics; D006801:Humans; D015999:Multivariate Analysis; D012086:Reoperation / Q000191:economics; D013548:Sweden; D019172:Transplantation Conditioning / Q000191:economics*; D014184:Transplantation, Homologous / Q000009:adverse effects / Q000191:economics; D061349:Unrelated Donors
chemical_list: D006680:HLA Antigens; D016179:Granulocyte Colony-Stimulating Factor