QUESTIONS UNDER STUDY / PRINCIPLES: Interest groups advocate centre-specific outcome data as a useful tool for patients in choosing a hospital for their treatment and for decision-making by politicians and the insurance industry. Haematopoietic stem cell transplantation (HSCT) requires significant infrastructure and represents a cost-intensive procedure. It therefore qualifies as a prime target for such a policy. METHODS: We made use of the comprehensive database of the Swiss Blood Stem Cells Transplant Group (SBST) to evaluate potential use of mortality rates. Nine institutions reported a total of 4717 HSCT - 1427 allogeneic (30.3%), 3290 autologous (69.7%) - in 3808 patients between the years 1997 and 2008. Data were analysed for survival- and transplantation-related mortality (TRM) at day 100 and at 5 years. RESULTS: The data showed marked and significant differences between centres in unadjusted analyses. These differences were absent or marginal when the results were adjusted for disease, year of transplant and the EBMT risk score (a score incorporating patient age, disease stage, time interval between diagnosis and transplantation, and, for allogeneic transplants, donor type and donor-recipient gender combination) in a multivariable analysis. CONCLUSIONS: These data indicate comparable quality among centres in Switzerland. They show that comparison of crude centre-specific outcome data without adjustment for the patient mix may be misleading. Mandatory data collection and systematic review of all cases within a comprehensive quality management system might, in contrast, serve as a model to ascertain the quality of other cost-intensive therapies in Switzerland.
QUESTIONS UNDER STUDY / PRINCIPLES: Interest groups advocate centre-specific outcome data as a useful tool for patients in choosing a hospital for their treatment and for decision-making by politicians and the insurance industry. Haematopoietic stem cell transplantation (HSCT) requires significant infrastructure and represents a cost-intensive procedure. It therefore qualifies as a prime target for such a policy. METHODS: We made use of the comprehensive database of the Swiss Blood Stem Cells Transplant Group (SBST) to evaluate potential use of mortality rates. Nine institutions reported a total of 4717 HSCT - 1427 allogeneic (30.3%), 3290 autologous (69.7%) - in 3808 patients between the years 1997 and 2008. Data were analysed for survival- and transplantation-related mortality (TRM) at day 100 and at 5 years. RESULTS: The data showed marked and significant differences between centres in unadjusted analyses. These differences were absent or marginal when the results were adjusted for disease, year of transplant and the EBMT risk score (a score incorporating patient age, disease stage, time interval between diagnosis and transplantation, and, for allogeneic transplants, donor type and donor-recipient gender combination) in a multivariable analysis. CONCLUSIONS: These data indicate comparable quality among centres in Switzerland. They show that comparison of crude centre-specific outcome data without adjustment for the patient mix may be misleading. Mandatory data collection and systematic review of all cases within a comprehensive quality management system might, in contrast, serve as a model to ascertain the quality of other cost-intensive therapies in Switzerland.
Authors: A Marek; M Stern; Y Chalandon; M Ansari; H Ozsahin; T Güngör; B Gerber; T Kühne; J R Passweg; A Gratwohl; A Tichelli; R Seger; U Schanz; J Halter; G Stussi Journal: Bone Marrow Transplant Date: 2013-09-16 Impact factor: 5.483
Authors: John A Snowden; Riccardo Saccardi; Kim Orchard; Per Ljungman; Rafael F Duarte; Myriam Labopin; Eoin McGrath; Nigel Brook; Carmen Ruiz de Elvira; Debra Gordon; Hélène A Poirel; Francis Ayuk; Yves Beguin; Francesca Bonifazi; Alois Gratwohl; Noel Milpied; John Moore; Jakob Passweg; J Douglas Rizzo; Stephen R Spellman; Jorge Sierra; Carlos Solano; Fermin Sanchez-Guijo; Nina Worel; Andreu Gusi; Gillian Adams; Theodor Balan; Helen Baldomero; Gilles Macq; Evelyne Marry; Florence Mesnil; Elena Oldani; Rachel Pearce; Julia Perry; Nicole Raus; Urs Schanz; Steven Tran; Leonie Wilcox; Grzegorz W Basak; Christian Chabannon; Selim Corbacioglu; Harry Dolstra; Jürgen Kuball; Mohamad Mohty; Arjan Lankester; Sylvia Montoto; Arnon Nagler; Jan Styczynski; Ibrahim Yakoub-Agha; Regis Peffault de Latour; Nicolaus Kroeger; Ronald Brand; Liesbeth C de Wreede; Erik van Zwet; Hein Putter Journal: Bone Marrow Transplant Date: 2019-10-21 Impact factor: 5.483