title: Costs and cost-effectiveness of allogeneic stem cell transplantation in children are predictable.
abstract: The overall costs of pediatric stem cell transplantation (SCT), including donor search and costs during the first year post-SCT, were calculated in a cohort of 141 consecutive children undergoing SCT in a single institution. Costs were correlated with patient and transplantation characteristics and with a risk score for transplantation-related mortality. Cost-effectiveness was calculated based on the overall cost per surviving patient. Life-years gained were extrapolated from overall survival, and the costs per expected life-year gained were calculated. The overall median cost was €136,382 (175,815$), with a wide range, of €26,897 (34,679$) to €601,348 (775,343$). Increased costs were significantly associated with age, use of donors other than matched siblings, and advanced disease. There was a strong correlation of costs with a simple transplantation-related mortality risk score; median total costs were €89,550 (115,463$) for a score of 0, €127,349 (164,179$) for a score of 1, €156,578 (201,861$) for a score of 2, and €274,915 (354,499$) for a score of 3 (P < .001). Cost-effectiveness decreased with increasing transplantation-related mortality risk score; costs per survivor increased from €93,209 (120,200$) for a score of 0 to a maximum of €1,216,348 (1,568,579$) for a score of 3. Costs associated with pediatric SCT vary substantially; however, the combination of variables such as age, disease, and donor type is predictive of costs and cost-effectiveness. Costs per life-year gained are within the broadly accepted range in life-threatening hemato-oncologic diseases, even in the most cost-intensive patient cohort.
authors.affiliation: Department of Pediatrics, St Anna Children's Hospital, Medical University of Vienna, Vienna, Austria. susanne.matthes@stanna.at
authors.forename: Susanne
authors.initials: S
authors.lastname: Matthes-Martin
authors.forename: Ulrike
authors.initials: U
authors.lastname: Pötschger
authors.forename: Ronald
authors.initials: R
authors.lastname: Barr
authors.forename: Manuel
authors.initials: M
authors.lastname: Martin
authors.forename: Heidrun
authors.initials: H
authors.lastname: Boztug
authors.forename: Thomas
authors.initials: T
authors.lastname: Klingebiel
authors.forename: Andishe
authors.initials: A
authors.lastname: Attarbaschi
authors.forename: Werner
authors.initials: W
authors.lastname: Eibler
authors.forename: Georg
authors.initials: G
authors.lastname: Mann
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D019337:Hematologic Neoplasms / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D011788:Quality of Life; D012107:Research Design; D018570:Risk Assessment; D035781:Siblings; D033581:Stem Cell Transplantation / Q000191:economics* / Q000706:statistics & numerical data; D016019:Survival Analysis; D014184:Transplantation, Homologous; D061349:Unrelated Donors; D055815:Young Adult