Costs of autologous and allogeneic hematopoietic cell transplantation in the United States: a study using a large national private claims database

Abstract

There is a lack of multi-center cost-identification studies for hematopoietic cell transplantation (HCT). We used a single longitudinal administrative claims database representing a national, commercially insured population to evaluate the feasibility of identifying HCT recipients and to establish a cohort of autologous and allogeneic HCT recipients to study inpatient and outpatient direct medical costs from transplant hospitalization through first 100 days post-transplantation. Using ICD-9 procedure and diagnosis codes, we identified 3365 patients who had received their first transplant in the United States between 2007 and 2009 (autologous, 1678, allogeneic, 1320, graft source not specified, 367). The median 100-day total costs for autologous HCT were $99,899 (interquartile range (IQR), $73,914-140,555), and for allogeneic HCT were $203,026 (IQR, $141,742-316 ,426). The majority of costs (>75%) occurred during the initial transplant hospitalization for both autologous and allogeneic HCT recipients. Costs were greater among pediatric (< or =20 years) compared with adult (>20 years) recipients and this difference was more pronounced with allogeneic HCT. Using a claims database representing a national HCT population, we highlight the high costs associated with autologous and allogeneic HCT. Our study lays the foundation for using claims data for future research on economic aspects of HCT.

Figure 1

Patient selection criteria.

Figure 2

Relative contribution of costs of hematopoietic cell transplant hospitalization, costs of any subsequent hospitalization and outpatient costs to total costs of hematopoietic cell transplantation in the first 100 days after transplantation.

Figure 3

Distribution of total costs in the first 100 days after transplantation by age for recipients of [A] autologous HCT and [B] allogeneic HCT. Each stacked column represents proportion of patients with total costs within the specified range.