title: Cost-Effectiveness of Autologous Hematopoietic Stem Cell Transplantation for Elderly Patients with Multiple Myeloma using the Surveillance, Epidemiology, and End Results-Medicare Database.
abstract: In the past decade, the number of autologous hematopoietic stem cell transplants (Auto HSCT) for older patients with multiple myeloma (MM) has increased dramatically, as has the cost of transplantation. The cost-effectiveness of this modality in patients over age 65 is unclear. Using the Surveillance, Epidemiology, and End Results-Medicare database to create a propensity-score matched sample of patients over age 65 between 2000 and 2007, we compared the survival and cost for those who received Auto HSCT to those who did not undergo transplantation but survived at least 6 months after diagnosis, and we calculated an incremental cost-effectiveness ratio (ICER). Two hundred seventy patients underwent transplantation. Median overall survival from diagnosis in those who underwent transplantation was significantly longer than in patients who did not (58 months versus 37 months, P < .001). For patients living longer than 2 years, the median monthly cost during the first year was significantly different, but the middle and last year of life costs were similar. The median cost of the first 100 days after transplantation was $60,000 (range, $37,000 to $85,000). The resultant ICER was $72,852 per life-year gained. Survival after transplantation was comparable to that in those who underwent transplantation patients under 65 years and significantly longer than older patients who did not undergo transplantation. With an ICER less than $100,000/life-year gained, Auto HSCT is cost-effective when compared with nontransplantation care in the era of novel agents and should be considered, where clinically indicated, for patients over the age of 65.
authors.affiliation: Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York. Electronic address: shahg@mskcc.org.
authors.forename: Gunjan L
authors.initials: GL
authors.lastname: Shah
authors.affiliation: Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts; Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Aaron N
authors.initials: AN
authors.lastname: Winn
authors.affiliation: Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Pei-Jung
authors.initials: PJ
authors.lastname: Lin
authors.affiliation: Division of Hematology/Oncology, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Andreas
authors.initials: A
authors.lastname: Klein
authors.affiliation: Division of Hematology/Oncology, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Kellie A
authors.initials: KA
authors.lastname: Sprague
authors.affiliation: Division of Hematology/Oncology, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Hedy P
authors.initials: HP
authors.lastname: Smith
authors.affiliation: Division of Hematology/Oncology, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Rachel
authors.initials: R
authors.lastname: Buchsbaum
authors.affiliation: Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Joshua T
authors.initials: JT
authors.lastname: Cohen
authors.affiliation: Division of Hematology/Oncology, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Kenneth B
authors.initials: KB
authors.lastname: Miller
authors.affiliation: Division of Hematology/Oncology, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Raymond
authors.initials: R
authors.lastname: Comenzo
authors.affiliation: Division of Hematology/Oncology, Tufts Medical Center, Boston, Massachusetts; Center for Health Solutions, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Susan K
authors.initials: SK
authors.lastname: Parsons
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D006278:Medicare / Q000191:economics; D009101:Multiple Myeloma / Q000188:drug therapy / Q000191:economics* / Q000401:mortality / Q000628:therapy; D019057:Quality-Adjusted Life Years; D018426:SEER Program; D014182:Transplantation, Autologous / Q000191:economics / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States
keywords: Autologous stem cell transplantation; Cost-effectiveness; Geriatric oncology; Multiple myeloma