Cost Implications of Comorbidity for Autologous Stem Cell Transplantation in Elderly Patients with Multiple Myeloma Using SEER-Medicare.
Comorbidity is more common in older patients and can increase the cost of care by increasing toxicity. Using the SEER-Medicare database from 2000 to 2007, we examined the costs and life-year benefit of Auto-HSCT for MM patients over the age of 65 by evaluating the difference over time relative to comorbidity burden. One hundred ten patients had an Auto-HSCT in the early time period (2000-2003) and 160 in the late time period (2004-2007). Patients were divided by a Charlson Comorbidity Index (CCI) of 0 or greater than 1 (CCI1+). Median overall survival was 53.5 months for the late time period patients compared to 40.3 months for the early time period patients (p= 0.031). Median costs for CCI0 versus CCI1+ in the early period were, respectively, $70,900 versus $72,000 (100 d); $86,100 versus $98,300 (1 yr); and $139,200 versus $195,300 (3 yrs). Median costs for late period were, respectively, $58,400 versus $60,400 (100 d); $86,300 versus $77,700 (1 yr); and $124,400 versus $110,900 (3 yrs). Comorbidity had a significant impact on survival and cost among early time period patients but not among late time period patients. Therefore, older patients with some comorbidities can be considered for Auto-HSCT depending on clinical circumstances.
Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Box 298 Avenue, New York, NY 10065, USA.
Gunjan L
0000-0002-9977-0456
GL
Shah
Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St., Box 63, Boston, MA 02111, USA.
Aaron
A
Winn
Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St., Box 63, Boston, MA 02111, USA.
Pei-Jung
PJ
Lin
Division of Hematology/Oncology, Department of Medicine, Tufts Medical Center, 800 Washington St., Box 245, Boston, MA 02111, USA.
Andreas
A
Klein
Division of Hematology/Oncology, Department of Medicine, Tufts Medical Center, 800 Washington St., Box 245, Boston, MA 02111, USA.
Kellie A
KA
Sprague
Division of Hematology/Oncology, Department of Medicine, Tufts Medical Center, 800 Washington St., Box 245, Boston, MA 02111, USA.
Hedy P
HP
Smith
Division of Hematology/Oncology, Department of Medicine, Tufts Medical Center, 800 Washington St., Box 245, Boston, MA 02111, USA.
Rachel
R
Buchsbaum
Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St., Box 63, Boston, MA 02111, USA.
Joshua T
JT
Cohen
Division of Hematology/Oncology, Department of Medicine, Tufts Medical Center, 800 Washington St., Box 245, Boston, MA 02111, USA.
Kenneth B
KB
Miller
Division of Hematology/Oncology, Department of Medicine, Tufts Medical Center, 800 Washington St., Box 245, Boston, MA 02111, USA.
Raymond
R
Comenzo
Division of Hematology/Oncology, Department of Medicine, Tufts Medical Center, 800 Washington St., Box 245, Boston, MA 02111, USA; Center for Health Solutions, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St., Box 345, Boston, MA 02111, USA.
Susan K
SK
Parsons