title: Safety and cost-effectiveness of outpatient autologous stem cell transplantation in patients with multiple myeloma.
abstract: High-dose chemotherapy with autologous stem cell transplantation (ASCT) remains the standard of care for patients with multiple myeloma. Outpatient ASCT can be an attractive option given wait times and costs associated with inpatient procedures. We initiated an outpatient transplantation protocol in 2006. Patients were treated at a university hospital outpatient clinic that was open 5 days a week. The present study investigated safety and cost-effectiveness of the outpatient program. Ninety-one patients underwent ASCT between 2006 and 2010. The majority of patients (77%) had Durie-Salmon stage III disease; 38% had 1 or more comorbidities. Seventy-six patients (84%) were hospitalized during the first 100 days, mainly for febrile neutropenia (n = 71). Overall survival at day 100 was 100%. No patient was admitted to an intensive care unit. Risk factors for prolonged hospitalization (longer than 7 days) were disease stage IIB or higher and age >60 years. The cost savings was $19,522 (Canadian dollars) per patient compared with inpatient ASCT, for an annual savings of approximately $740,000. In summary, outpatient ASCT performed in a weekday clinic for patients with multiple myeloma appears to be safe and cost-effective, but is associated with a relatively high hospitalization rate.
authors.affiliation: Division of Hemato-Oncology, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Andreas
authors.initials: A
authors.lastname: Holbro
authors.forename: Imran
authors.initials: I
authors.lastname: Ahmad
authors.forename: Sandra
authors.initials: S
authors.lastname: Cohen
authors.forename: Jean
authors.initials: J
authors.lastname: Roy
authors.forename: Silvy
authors.initials: S
authors.lastname: Lachance
authors.forename: Miguel
authors.initials: M
authors.lastname: Chagnon
authors.forename: Richard
authors.initials: R
authors.lastname: LeBlanc
authors.forename: Lea
authors.initials: L
authors.lastname: Bernard
authors.forename: Lambert
authors.initials: L
authors.lastname: Busque
authors.forename: Denis Claude
authors.initials: DC
authors.lastname: Roy
authors.forename: Guy
authors.initials: G
authors.lastname: Sauvageau
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Kiss
mesh_terms: D000328:Adult; D000367:Age Factors; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000191:economics* / Q000401:mortality / Q000628:therapy; D009367:Neoplasm Staging; D009503:Neutropenia / Q000150:complications / Q000191:economics / Q000401:mortality / Q000628:therapy; D010045:Outpatients; D012189:Retrospective Studies; D016019:Survival Analysis; D014182:Transplantation, Autologous
chemical_list: D000970:Antineoplastic Agents