Economic Analysis of Unrelated Allogeneic Bone Marrow Transplantation: Results From The Randomized Clinical Trial of T-Cell Depletion vs Unmanipulated Grafts for the Prevention of Graft-Versus-Host Disease
Year of Publication
de Lissovoy, G; Hurd, D; Carter, S; Beatty, P; Ewell, M; Henslee-Downey, J; Kernan, N; Yanovich, S; Weisdorf, B
Bone Marrow Transplant
Adolescent; Adult; Bone Marrow Transplantation; Child; Costs and Cost Analysis; Female; Graft vs Host Disease; Infant; infection; Length of Stay; Lymphocyte Depletion; Male; Middle Aged; Transplantation- Homologous
Unrelated-donor marrow transplantation is a potential option for transplant candidates lacking a compatible related donor. The T-cell Depletion Study compared the 3-year disease-free survival for patients receiving T-cell-depleted (TCD) donor marrow (n = 203) vs unmanipulated donor marrow with methotrexate and cyclosporine (M/C) (n = 207). Hospital costs during index admission were documented with billing data, while hospital costs during subsequent 6-month follow-up were estimated from case report forms. Patients with index admission billing were included in the analysis (TCD = 119, M/C = 127). Total hospital length of stay (LOS) was similar across groups, with medians 47.0 days for TCD and 52.0 days for M/C (P = 0.72). Total hospital costs were comparable, 145,115 dollars vs 141,981 dollars (P = 0.63) for TCD and M/C, respectively. However, controlling for site and patient characteristics, TCD was associated with a 12.1% reduction in LOS for the index admission (95% CI -19.4%, -4.3%). Independent of treatment, HLA matching (6/6) was associated with an 8.6% (95% CI -17.4%, +1.2%) reduction in the index admission LOS, while cost was lower by 15.8% (95% CI -26.7%, -3.3%). Treatment costs were similar for TCD and M/C study groups. Savings on reduced cost for treating acute graft-versus-host disease were likely offset by increase in serious infections in the TCD arm.
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