title: Cost-effectiveness of the introduction of specialized oral care with laser therapy in hematopoietic stem cell transplantation.
abstract: Oral mucositis (OM) is one of the side effects of hematopoietic stem cell transplantation (HSCT), resulting in major morbidity. The aim of this study was to determine the cost-effectiveness of the introduction of a specialized oral care program including laser therapy in the care of patients receiving HSCT with regard to morbidity associated with OM. Clinical information was gathered on 167 patients undergoing HSCT and divided according to the presence (n = 91) or absence (n = 76) of laser therapy and oral care. Cost analysis included daily hospital fees, parenteral nutrition (PN) and prescription of opioids. It was observed that the group without laser therapy (group II) showed a higher frequency of severe degrees of OM (relative risk = 16.8, 95% confidence interval -5.8 to 48.9, p < 0.001), with a significant association between this severity and the use of PN (p = 0.001), prescription of opioids (p < 0.001), pain in the oral cavity (p = 0.003) and fever > 37.8°C (p = 0.005). Hospitalization costs in this group were up to 30% higher. The introduction of oral care by a multidisciplinary staff including laser therapy helps reduce morbidity resulting from OM and, consequently, helps minimize hospitalization costs associated with HSCT, even considering therapy costs.
authors.affiliation: Unit of Bone Marrow Transplantation, Hospital Israelita Albert Einstein, São Paulo, Brazil; Department of Social Dentistry, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Letícia Mello
authors.initials: LM
authors.lastname: Bezinelli
authors.forename: Fernanda
authors.initials: F
authors.lastname: de Paula Eduardo
authors.forename: Roberta Marques
authors.initials: RM
authors.lastname: da Graça Lopes
authors.forename: Maria Gabriela Haye
authors.initials: MG
authors.lastname: Biazevic
authors.forename: Carlos
authors.initials: C
authors.lastname: de Paula Eduardo
authors.forename: Luciana
authors.initials: L
authors.lastname: Correa
authors.forename: Nelson
authors.initials: N
authors.lastname: Hamerschlak
authors.forename: Edgard
authors.initials: E
authors.lastname: Michel-Crosato
mesh_terms: D000328:Adult; D000368:Aged; D064591:Allografts / Q000191:economics; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000191:economics; D000935:Antifungal Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics / Q000627:therapeutic use; D001938:Brazil; D016022:Case-Control Studies; D003362:Cost-Benefit Analysis; D003815:Dentists / Q000191:economics; D016527:Drug Costs; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000191:economics; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D028022:Low-Level Light Therapy / Q000191:economics / Q000379:methods; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000191:economics / Q000627:therapeutic use; D009294:Narcotics / Q000191:economics / Q000627:therapeutic use; D009894:Opportunistic Infections / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D009910:Oral Hygiene / Q000191:economics / Q000379:methods*; D010288:Parenteral Nutrition / Q000191:economics; D010348:Patient Care Team; D012189:Retrospective Studies; D012648:Self Care / Q000191:economics; D013280:Stomatitis / Q000191:economics / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D019172:Transplantation Conditioning / Q000009:adverse effects* / Q000191:economics; D014182:Transplantation, Autologous / Q000191:economics
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D007166:Immunosuppressive Agents; D019653:Myeloablative Agonists; D009294:Narcotics
keywords: hematopoietic stem cell transplantation; low-level laser therapy; oral hygiene; oral mucositis