BACKGROUND:Allogeneic hematopoietic stem-cell transplantation is a widely used, cost-intensive procedure. Our purpose was to estimate costs and determine cost predictors. METHODS: We used data from a prospective French study comparing four doses of immunoglobulins. Resource use of hematopoietic stem-cell transplant recipients during the first 6 months posttransplant, both inpatient and ambulatory costs, in 85 patients from five centers were collected prospectively and costed. Baseline data and clinical events were retrieved. Protocol-driven costs were excluded. Multivariable analysis evaluated the association between costs and patient's pretransplant status and transplant-related complications. Because of the absence of differences in outcome among the four randomization groups, cost data for all patients were pooled. RESULTS:Total costs per patient were the following: mean 76,237 Euros; standard deviation 32,565 Euros; median 69,516 Euros; range 183,758 to 14,761Euros. The major cost driver was hospital days. No association was found between costs and baseline status. The "predictors" of higher costs (adding an average 20,000 Euros/patient) were the occurrence of transplant-related complications: graft-versus-host disease and repeated infections that were unpredictable before transplant in this homogeneous group of patients. CONCLUSION: Our data highlight the discrepancy between the Diagnosis Related Group prospective payment system and actual costs. The actual cost of geno-identical stem-cell transplantation results from posttransplant complications that cannot be predicted prospectively and require ex post cost adjustment.
RCT Entities:
BACKGROUND: Allogeneic hematopoietic stem-cell transplantation is a widely used, cost-intensive procedure. Our purpose was to estimate costs and determine cost predictors. METHODS: We used data from a prospective French study comparing four doses of immunoglobulins. Resource use of hematopoietic stem-cell transplant recipients during the first 6 months posttransplant, both inpatient and ambulatory costs, in 85 patients from five centers were collected prospectively and costed. Baseline data and clinical events were retrieved. Protocol-driven costs were excluded. Multivariable analysis evaluated the association between costs and patient's pretransplant status and transplant-related complications. Because of the absence of differences in outcome among the four randomization groups, cost data for all patients were pooled. RESULTS: Total costs per patient were the following: mean 76,237 Euros; standard deviation 32,565 Euros; median 69,516 Euros; range 183,758 to 14,761Euros. The major cost driver was hospital days. No association was found between costs and baseline status. The "predictors" of higher costs (adding an average 20,000 Euros/patient) were the occurrence of transplant-related complications: graft-versus-host disease and repeated infections that were unpredictable before transplant in this homogeneous group of patients. CONCLUSION: Our data highlight the discrepancy between the Diagnosis Related Group prospective payment system and actual costs. The actual cost of geno-identical stem-cell transplantation results from posttransplant complications that cannot be predicted prospectively and require ex post cost adjustment.
Authors: Akiko M Saito; Corey Cutler; David Zahrieh; Robert J Soiffer; Vincent T Ho; Edwin P Alyea; John Koreth; Joseph H Antin; Stephanie J Lee Journal: Biol Blood Marrow Transplant Date: 2008-02 Impact factor: 5.742
Authors: Karen K Ballen; Steven Joffe; Ruta Brazauskas; Zhiwei Wang; Mahmoud D Aljurf; Görgün Akpek; Christopher Dandoy; Haydar A Frangoul; César O Freytes; Nandita Khera; Hillard M Lazarus; Charles F LeMaistre; Paulette Mehta; Susan K Parsons; David Szwajcer; Celalettin Ustun; William A Wood; Navneet S Majhail Journal: Biol Blood Marrow Transplant Date: 2014-07-23 Impact factor: 5.742
Authors: Lynn El Haddad; Shashank S Ghantoji; Anne K Park; Marjorie V Batista; Jonathan Schelfhout; Jack Hachem; Yadira Lobo; Ying Jiang; Gabriela Rondon; Richard Champlin; Roy F Chemaly Journal: J Med Virol Date: 2019-09-03 Impact factor: 2.327
Authors: Navneet S Majhail; Jaya M Mothukuri; Margaret L Macmillan; Michael R Verneris; Paul J Orchard; John E Wagner; Daniel J Weisdorf Journal: Pediatr Blood Cancer Date: 2010-01 Impact factor: 3.167