title: Cost-effectiveness analysis of early vs. late autologous stem cell transplantation in multiple myeloma.
abstract: BACKGROUND
  Autologous stem cell transplant (ASCT) is the current standard of care for most patients with multiple myeloma (MM) who are transplant eligible, yet the timing of ASCT is disputed due to a similar overall (OS) and progression-free survival with an early ASCT (eASCT) or a delayed ASCT (dASCT) approach.
  
  
  OBJECTIVE
  We developed a decision analytic model to perform cost-effectiveness analysis of the two commonly used treatment strategies for MM.
  
  
  METHODS
  Data on disease progression and treatment effectiveness came from 2001 to 2008 cohort treated at the Mayo Clinic and from published studies. Cost analysis was performed from a third-party payer perspective.
  
  
  RESULTS
  The Consumer Price Index adjusted 2012 costs of eASCT and dASCT were $249 236 and $262 610, respectively. eASCT cohort had a benefit of 1.96 quality-adjusted life years (QALYs), 0.23 QALYs more than dASCT, implying that eASCT is preferred (dominant) over dASCT. The most critical variables in one-way sensitivity analysis were treatment-related mortality and OS associated with eASCT strategy.
  
  
  CONCLUSIONS
  We conclude that eASCT could potentially be a relatively cost-effective treatment option for appropriate patients with MM, and these results would help patients, providers, and payers in decision making for timing of ASCT.
authors.affiliation: Department of Public Health Sciences, University of Rochester, Rochester, NY, USA.
authors.forename: Chintan
authors.initials: C
authors.lastname: Pandya
authors.forename: Shahrukh
authors.initials: S
authors.lastname: Hashmi
authors.forename: Nandita
authors.initials: N
authors.lastname: Khera
authors.forename: Morie A
authors.initials: MA
authors.lastname: Gertz
authors.forename: Angela
authors.initials: A
authors.lastname: Dispenzieri
authors.forename: William
authors.initials: W
authors.lastname: Hogan
authors.forename: Mustaqeem
authors.initials: M
authors.lastname: Siddiqui
authors.forename: Katia
authors.initials: K
authors.lastname: Noyes
authors.forename: Shaji K
authors.initials: SK
authors.lastname: Kumar
mesh_terms: D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics*; D006801:Humans; D009101:Multiple Myeloma / Q000191:economics* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D011379:Prognosis; D015996:Survival Rate; D014182:Transplantation, Autologous
keywords: autologous stem cell transplant; cost-effective analysis; decision tree; early vs. delayed stem cell transplant; multiple myeloma