title: Allogeneic Hematopoietic Cell Transplantation for Children with Sickle Cell Disease Is Beneficial and Cost-Effective: A Single-Center Analysis.
abstract: Limited data exist regarding health care utilization (HCU) in patients receiving allogeneic hematopoietic cell transplantation (alloHCT) for sickle cell disease. Financial data from 2002 to 2011 were analyzed for 26 alloHCT patients and 48 control subjects (referred but without alloHCT). HCU of alloHCT was determined over 3 time periods: pre-alloHCT, during alloHCT (day 0 to day +365), and post-alloHCT. The median total cost per patient during the alloHCT year was $413,000 inpatient and $18,000 outpatient. Post-alloHCT HCU decreased when compared with pre-alloHCT and control subjects. The median cost of post-alloHCT outpatient visits per patient was significantly less when compared with pre-alloHCT (P = .044). The median cost of post-alloHCT inpatient visits per patient approached significance when compared with those pre-alloHCT (P = .079). Sixteen post-alloHCT patients, 19 control subjects, and 14 unaffected siblings were surveyed using Pediatric Quality of Life Inventory and EuroQOL questionnaires; however, the questionnaire scores across all 3 patient groups were not statistically significant (P = .2638). When adjusted for health-related quality of life, the analysis suggested alloHCT has a positive impact on health-related quality of life over control subjects. These pilot data support our hypothesis that alloHCT in children with sickle cell disease reduces HCU compared with control subjects without alloHCT.
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, New York. Electronic address: sa2812@columbia.edu.
authors.forename: Staci D
authors.initials: SD
authors.lastname: Arnold
authors.affiliation: Mailman School of Public Health, Columbia University Medical Center, New York, New York.
authors.forename: Zhezhen
authors.initials: Z
authors.lastname: Jin
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, New York.
authors.forename: Stephen
authors.initials: S
authors.lastname: Sands
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, New York.
authors.forename: Monica
authors.initials: M
authors.lastname: Bhatia
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, New York.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Kung
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, New York.
authors.forename: Prakash
authors.initials: P
authors.lastname: Satwani
mesh_terms: D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000191:economics* / Q000473:pathology / Q000523:psychology / Q000628:therapy; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics*; D006801:Humans; D007223:Infant; D010865:Pilot Projects; D011788:Quality of Life / Q000523:psychology; D011795:Surveys and Questionnaires; D014184:Transplantation, Homologous
keywords: Cost; Outcomes; Pediatric; Quality of life; Sickle cell disease; Transplant