title: Economics and Outcome After Hematopoietic Stem Cell Transplantation: A Retrospective Cohort Study.
abstract: Hematopoietic stem cell transplantation (HSCT) is a lifesaving expensive medical procedure. Hence, more transplants are performed in more affluent countries. The impact of economic factors on patient outcome is less defined. We analyzed retrospectively a defined cohort of 102,549 patients treated with an allogeneic (N = 37,542; 37%) or autologous (N = 65,007; 63%) HSCT. They were transplanted by one of 404 HSCT centers in 25 European countries between 1999 and 2006. We searched for associations between center-specific microeconomic or country-specific macroeconomic factors and outcome. Center patient-volume and center program-duration were significantly and systematically associated with improved survival after allogeneic HSCT (HR 0·87; 0·84-0·91 per 10 patients; p < 0·0001; HR 0·90;0·85-0·90 per 10 years; p < 0·001) and autologous HSCT (HR 0·91;0·87-0·96 per 10 patients; p < 0·001; HR 0·93;0·87-0·99 per 10 years; p = 0·02). The product of Health Care Expenditures by Gross National Income/capita was significantly associated in multivariate analysis with all endpoints (R(2) = 18%; for relapse free survival) after allogeneic HSCT. Data indicate that country- and center-specific economic factors are associated with distinct, significant, systematic, and clinically relevant effects on survival after HSCT. They impact on center expertise in long-term disease and complication management. It is likely that these findings apply to other forms of complex treatments.
authors: EBMT Activity Survey Office, University Hospital, Basel, Switzerland.
authors: Alois
authors: A
authors: Gratwohl
authors: JACIE Accreditation Office, Barcelona, Spain.
authors: Anna
authors: A
authors: Sureda
authors: EBMT Activity Survey Office, University Hospital, Basel, Switzerland.
authors: Helen
authors: H
authors: Baldomero
authors: Institute for Operations Research and Computational Finances, University of St. Gallen, Switzerland.
authors: Michael
authors: M
authors: Gratwohl
authors: Hematology, Heidelberg, Germany.
authors: Peter
authors: P
authors: Dreger
authors: Hematology, University Hospital Hamburg, Hamburg, Germany.
authors: Nicolaus
authors: N
authors: Kröger
authors: Hematology, University Hospital and Karolinska Institutet, Stockholm, Sweden.
authors: Per
authors: P
authors: Ljungman
authors: JACIE Accreditation Office, Barcelona, Spain.
authors: Eoin
authors: E
authors: McGrath
authors: Hematology, Hôpital St. Antoine, Paris, France.
authors: Mohamad
authors: M
authors: Mohty
authors: Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors: Arnon
authors: A
authors: Nagler
authors: Hematology, Ospedali Riuniti di Bergamo Papa Giovanni XXIII, Bergamo, Italy.
authors: Alessandro
authors: A
authors: Rambaldi
authors: EBMT Data Office, London, UK.
authors: Carmen Ruiz
authors: CR
authors: de Elvira
authors: Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, University of Sheffield, Sheffield, UK; Department of Oncology, University of Sheffield, Sheffield, UK.
authors: John A
authors: JA
authors: Snowden
authors: EBMT Activity Survey Office, University Hospital, Basel, Switzerland.
authors: Jakob
authors: J
authors: Passweg
authors: Haematology, Hammersmith Hospital, London, United Kingdom.
authors: Jane
authors: J
authors: Apperley
authors: Hematology and Oncology, University Hospital, Leipzig, Germany.
authors: Dietger
authors: D
authors: Niederwieser
authors: Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands.
authors: Theo
authors: T
authors: Stijnen
authors: Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands.
authors: Ronald
authors: R
authors: Brand
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D005060:Europe / Q000453:epidemiology; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D017063:Outcome Assessment, Health Care; D062486:Public Health Surveillance; D012008:Recurrence; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D055815:Young Adult
keywords: Center effect; GNI/cap; HCE/cap; HDI; Hematopoietic stem cell transplantation; Macroeconomics; Microeconomics; Outcome; Patient volume; Program duration; Risk assessment; Survival