title: Cost-effectiveness and clinical outcomes of double versus single cord blood transplantation in adults with acute leukemia in France.
abstract: Double cord blood transplantation extends the use of cord blood to adults for whom a single unit is not available, but the procedure is limited by its cost. To evaluate outcomes and cost-effectiveness of double compared to single cord blood transplantation, we analyzed 134 transplants in adults with acute leukemia in first remission. Transplants were performed in France with reduced intensity or myeloablative conditioning regimens. Costs were estimated from donor search to 1 year after transplantation. A Markov decision analysis model was used to calculate quality-adjusted life-years and cost-effectiveness ratio within 4 years. The overall survival at 2 years after single and double cord blood transplants was 42% versus 62%, respectively (P=0.03), while the leukemia-free-survival was 33% versus 53%, respectively (P=0.03). The relapse rate was 21% after double transplants and 42% after a single transplant (P=0.006). No difference was observed for non-relapse mortality or chronic graft-versus-host-disease. The estimated costs up to 1 year after reduced intensity conditioning for single and double cord blood transplantation were € 165,253 and €191,827, respectively. The corresponding costs after myeloablative conditioning were € 192,566 and € 213,050, respectively. Compared to single transplants, double cord blood transplantation was associated with supplementary costs of € 21,302 and € 32,420 up to 4 years, but with increases in quality-adjusted life-years of 0.616 and 0.484, respectively, and incremental cost-effectiveness ratios of € 34,581 and €66,983 in the myeloablative and reduced intensity conditioning settings, respectively. Our results showed that for adults with acute leukemia in first complete remission in France, double cord transplantation is more cost-effective than single cord blood transplantation, with better outcomes, including quality-adjusted life-years.
authors.affiliation: annalisa.ruggeri@sat.aphp.fr.
authors.forename: Myriam
authors.initials: M
authors.lastname: Labopin
authors.forename: Annalisa
authors.initials: A
authors.lastname: Ruggeri
authors.forename: Norbert Claude
authors.initials: NC
authors.lastname: Gorin
authors.forename: Eliane
authors.initials: E
authors.lastname: Gluckman
authors.forename: Didier
authors.initials: D
authors.lastname: Blaise
authors.forename: Lionel
authors.initials: L
authors.lastname: Mannone
authors.forename: Noel
authors.initials: N
authors.lastname: Milpied
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Yakoub-Agha
authors.forename: Eric
authors.initials: E
authors.lastname: Deconinck
authors.forename: Mauricette
authors.initials: M
authors.lastname: Michallet
authors.forename: Nathalie
authors.initials: N
authors.lastname: Fegueux
authors.forename: Gerard
authors.initials: G
authors.lastname: Socié
authors.forename: Stephanie
authors.initials: S
authors.lastname: Nguyen
authors.forename: Jean Yves
authors.initials: JY
authors.lastname: Cahn
authors.forename: Thierry
authors.initials: T
authors.lastname: de Revel
authors.forename: Federico
authors.initials: F
authors.lastname: Garnier
authors.forename: Catherine
authors.initials: C
authors.lastname: Faucher
authors.forename: Namik
authors.initials: N
authors.lastname: Taright
authors.forename: Chantal
authors.initials: C
authors.lastname: Kenzey
authors.forename: Fernanda
authors.initials: F
authors.lastname: Volt
authors.forename: Dominique
authors.initials: D
authors.lastname: Bertrand
authors.forename: Mohamad
authors.initials: M
authors.lastname: Mohty
authors.forename: Vanderson
authors.initials: V
authors.lastname: Rocha
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects / Q000191:economics; D003362:Cost-Benefit Analysis; D005602:France; D006086:Graft vs Host Disease / Q000209:etiology; D006801:Humans; D007938:Leukemia / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult