Costs of allogeneic hematopoietic cell transplantation with high-dose regimens

Abstract

To characterize the costs of allogeneic hematopoietic cell transplantation with high-dose regimens (HDCT), we analyzed clinical information and costs of 315 HDCT recipients during a 4-year study period beginning in 2000. Multivariate analyses were performed to identify pre- and/or post-HDCT factors predicting higher costs within the first year. Overall survival (OS) at 100 days and 1 year were 80% and 58%, respectively. The median cost and days of hospitalization were $102,574 in 2004 US dollars and 36 days in the hospital for 100 days, and $128,800 and 39 days in the hospital for 1 year. Early costs, defined as costs within the first 100 days, accounted for 84% of total costs within the first year. Inpatient costs comprise 94% of the early costs, but only 61% of the later costs defined as costs incurred between 101 days and 1 year. Of the pre-HDCT factors, unrelated donors and advanced disease risk were significantly associated with increased cost. When post-HDCT events were also considered, these pre-HDCT factors were no longer independently predictive of high cost. Instead, severe complications post-HDCT were associated with higher costs, increasing total costs $20,228 on average. If no complications occurred, the mean cost within the first year was $79,222. These results provide cost estimates for complicated and uncomplicated HDCT procedures, as well as costs for management of specific transplant complications.

Figure 1. Characteristics of costs during the first year

(A) Proportion of costs by phase after transplantation. Abbreviation: early phase, initial admission through 100 days after transplantation; later phase, from 101 days to 1 year (365 days) after transplantation. (B) Relationship between total costs and disease-free survival during the first year by each year of transplantation. Boxes indicate the median costs in 2004 dollars within the first year post-HDCT. Lines indicate the disease-free survival at 1 year. Numbers of patients in each transplant year are shown in the parentheses.

Figure 2. Relationship between costs and post-transplant events or death

(A) Costs and overall survival during the first year after transplantation by number of complications. Boxes indicate the estimated mean costs in 2004 dollars for the first year after transplantation, which were adjusted for patient and transplant characteristics and the 95% confidence interval were shown by the full range of upper and lower whiskers. Lines indicate the overall survival at 1 year. Late neutrophil recovery, veno-occlusive disease, idiopathic pneumonia/diffuse alveolar hemorrhage, severe infection, severe renal/bladder toxicity (≥grade 3), severe neurological toxicity (≥grade 3), severe cardiac toxicity (≥grade 3), grade II to IV acute GVHD, extensive chronic GVHD, relapse, and in-hospital death during the first year were considered. Numbers of patients with each number of complications are shown in the parentheses. (B) Costs during the first year after transplantation for deceased or surviving patients.