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. 2019 Jan;25(1):41-46.
doi: 10.1016/j.bbmt.2018.08.030. Epub 2018 Sep 6.

Significant Nationwide Variability in the Costs and Hospital Mortality Rates of Autologous Stem Cell Transplantation for Multiple Myeloma: An Analysis of the Nationwide Inpatient Sample Database

Yuzhou Liu  1 , Hedong Han  2 , Gunjan Shah  3 , Sergio Giralt  3 , C Ola Landgren  3 , Jia He  4 , Alexander M Lesokhin  5
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Significant Nationwide Variability in the Costs and Hospital Mortality Rates of Autologous Stem Cell Transplantation for Multiple Myeloma: An Analysis of the Nationwide Inpatient Sample Database

Yuzhou Liu et al. Biol Blood Marrow Transplant. 2019 Jan.

Abstract

Autologous hematopoietic stem cell transplantation (AHCT) is the standard of care for eligible patients with multiple myeloma (MM). In this study, we explored disparities in hospital cost and in-hospital mortality among patients with MM who underwent AHCT. Data were obtained from the Nationwide Inpatient Sample database for 2005 to 2014. International Classification of Diseases, Ninth Edition, Clinical Modification diagnosis and procedure codes were used to identify patients. Hospitals were divided into quintiles according to the weighted volume of AHCTs performed in patients with MM. Multiple imputation with chained equation was used for missing data. Linear trend analysis of age- and sex-adjusted mortality, as well as inflation-adjusted hospital cost, was performed. Univariate regression screening followed by stepwise multivariate regression was performed for dependent variables, including mortality and inflation-adjusted hospital cost. Identified significant predictors underwent sensitivity analyses. Overall age- and sex-adjusted mortality rates and inflation-adjusted hospital costs decreased between 2005 and 2014; however, tremendous nationwide variability exists. Patients who underwent AHCT at very-low-volume hospitals (Q1) had significantly higher in-hospital mortality. Both geographic location and hospital type had impacted age- and sex-adjusted mortality rates and inflation-adjusted hospital costs. Despite an overall improvement in mortality and decreased cost of AHCT for patients with MM, nationwide variability in care exists. Further study is needed to identify correctable factors that contribute to the identified correlation.

Keywords: Healthcare disparity; Multiple myeloma; Stem cell transplantation.

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Conflict of interest statement

Disclaimer: Authors declare no conflict of interest

Figures

Figure 1
Figure 1
AUTO-SCT for MM In-Hospital Mortality from 2005 to 2014, Z=10.132, p<0.001
Figure 2
Figure 2
Trend analysis for inflation-adjusted hospitalization cost of AUTO-SCT in MM patients: 2005-2014, P<0.01
Figure 3
Figure 3
Weighted volume vs Mortality in autologous stem cell transplantation for Myeloma patients
See this image and copyright information in PMC

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