Comparison of Graft Acquisition and Early Direct Charges of Haploidentical Related Donor Transplantation versus Umbilical Cord Blood Transplantation

Abstract

Alternative donor allogeneic hematopoietic cell transplants (HCTs), such as double umbilical cord blood transplants (dUCBT) and haploidentical related donor transplants (haplo-HCT), have been shown to be safe and effective in adult patients who do not have an HLA-identical sibling or unrelated donor available. Most transplant centers have committed to 1 of the 2 alternative donor sources, even with a lack of published randomized data directly comparing outcomes and comparative data on the cost-effectiveness of dUCBT versus haplo-HCT. We conducted a retrospective study to evaluate and compare the early costs and charges of haplo-HCT and dUCBT in the first 100 days at 2 US transplant centers. Forty-nine recipients of haplo-HCT (at 1 center) and 37 with dUCBT (at another center) were included in the analysis. We compared graft acquisition, inpatient/outpatient, and total charges in the first 100 days. The results of the analysis showed a significantly lower cost of graft acquisition and lower total charges (for 100-day HCT survivors) in favor of haplo-HCT. Importantly, to control for the obvious shortcomings of comparing costs at 2 different transplant centers, adjustments were made based on the current (2018) local wage index and inflation rate. In the absence of further guidance from a prospective study, the cost analysis in this study suggests that haplo-HCT may result in early cost savings over dUCBT and may be preferred by transplant centers and for patients with more limited resources.

Umbilical cord blood: The promise and the uncertainty

“…Median 100‐day charges, including inpatient, outpatient, and graft acquisition, was $605 000 for UCB transplant (range $318 000‐$1 407 000) compared to $562 000 for haploidentical transplant (range $285 000‐$1 479 000). In this study, overall survival, progression‐free survival, and TRM were worse with UCB transplant 25 . In a study of hospital length of stay in the first 100 days after transplant in adult recipients, UCB was associated with fewer days alive and out of the hospital compared to matched unrelated donors and mismatched unrelated donors 26 .…”

“…Graft source acquisition costs and costs of the transplant are unique to the use of UCB units in contrast to other graft sources 25,26 . In a study at Medical College of Wisconsin and West Virginia University, acquisition charges for two units of UCB were $88 000 vs $35 000 for a haploidentical donor.…”

Reimbursement, Utilization, and 1-Year Survival Post-Allogeneic Transplantation for Medicare Beneficiaries With Acute Myeloid Leukemia

“…An internal post hoc analysis revealed that cord blood had the highest mean costs for acquisition and related services ($36 321), followed by peripheral blood ($14 855) and bone marrow ($5876) derived from the present CCR analysis. The association of donor type with reimbursement could change due to recent increased use of haploidentical-HCT (30,31). However, very few patients (<11) received haplo-HCTs during the study period (2010–2011).…”

Haploidentical Hematopoietic Stem Cell Transplantation Followed by ‘Post-Cyclophosphamide’: The Future of Allogeneic Stem Cell Transplant

“…In large part due to the advent of new conditioning and GvHD prophylactic regimens, such complications have been significantly reduced. In multiple recent studies of transplants for hematologic malignancies, haploidentical transplants had noninferior and, at times, superior outcomes compared with MMUDs, UCB, and even matched donors [5,7,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. In this review, we will compare haploidentical donor outcomes with outcomes using other donor sources.…”