Association of hematopoietic cell transplantation-specific comorbidity index with resource utilization after allogeneic transplantation

Abstract

Comorbidities affect clinical outcomes and costs in medicine. The hematopoietic cell transplantation (HCT)-specific comorbidity index (HCT-CI) predicts mortality risk after HCT. Its association with resource utilization (RU) is unknown. In this single-center, retrospective study, we examined the association of HCT-CI with RU (readmissions, length of hospital stay (LOS) and days out of hospital alive (DOHA)) in first 100 days (n=328) and 1 year (n=226) in allogeneic HCT patients from January 2010 to June 2014. Age, disease risk, conditioning and use of antithymocyte globulin were significantly different in the four groups with HCT-CI 0 to1 (n=138), 2 (n=56), 3 (n=55) or ⩾4 (n=79). Although the readmissions were higher in the first 100 days for patients with HCT-CI >0-1 (P=0.03), they were not significantly different in patients over 1 year (P=0.13). In the multivariable analysis, patients with HCT-CI score of >0 to 1 had increased LOS and fewer DOHA in both 100 days and 1 year after HCT. In this exploratory analysis, we found that HCT-CI >0 to 1 is associated with increased RU after allogeneic HCT. Recognizing predictors of RU can identify patients at risk of high utilization and help understand what drives health-care costs.

Increased Health Care Utilization and Costs during Allogeneic Hematopoietic Cell Transplantation for Acute Leukemia and Myelodysplastic Syndromes in Adolescents and Young Adults Compared with Children: A Multicenter Study

“…We were also unable to ascertain the influence of pre-HCT comorbidities on costs and resource utilization, as shown in previous in single-center studies. Decook et al [36] reported that adult HCT recipients with a higher pre-HCT comorbidity index had greater resource utilization, as defined by hospital LOS and readmission rate.…”

Age Adjusted Comorbidity Risk Index Does Not Predict Outcomes in an Autologous Hematopoietic Stem Cell Transplant Population

“…Although data exist in allogeneic populations, there is no literature evaluating other clinically meaningful outcomes such as time to engraftment, transfer to intensive care unit (ICU), or resource utilization in autologous HCT patients based on HCT-CI-Age. HCT is costly, and current data outline the association of HCT-CI with resource utilization in an allogeneic group 28 . As healthcare margins continue to narrow, it is imperative to evaluate resource-utilization in the autologous arena.…”