Do minitransplants have minicosts? A cost comparison between myeloablative and nonmyeloablative allogeneic stem cell transplant in patients with acute myeloid leukemia

Abstract

Summary:Allogeneic hematopoietic stem cell transplantation (SCT) is a widely used, cost-intensive procedure. Although pretransplant nonmyeloablative (NMA) or reduced-intensity conditioning regimens appear very promising, prospective studies comparing this approach with the conventional myeloablative (MA) approach in specific hematologic diseases are necessary, especially in patients in whom the conventional approach is not contraindicated. Cost may be an important factor in the decision-making process. We compared the costs of MA and NMA transplants in patients with acute myeloid leukemia (AML). We estimated 1-year resource utilization in 12 consecutive MA patients (median age: 39 years) and in 11 consecutive NMA patients (median age: 58 years) who underwent HLA-identical sibling SCT for AML. Resources care expenses were valued using the average daily rate for personnel costs, supplies, and room costs. Other data were directly collected from the patients' charts. Despite a trend for lower costs in NMA patients during the first 6 months, costs during the 6-12-month period were significantly higher after NMA due to late complications and readmissions (P ¼ 0.03). Finally, mean 1-year costs were not different in MA and NMA patients (P ¼ 0.75). Prospective studies comparing conventional and NMA approaches in homogeneous populations should include economic items. Bone Marrow Transplantation (2005) 36, 649-654. doi:10.1038/sj.bmt.1705109; published online 25 July 2005 Keywords: allogeneic hematopoietic stem cell transplantation; costs; reduced-intensity conditioning regimen Nonmyeloablative (NMA) or reduced intensity conditioning regimens for allogeneic stem cell transplants (SCT) were mainly developed for older patients and those with contraindications to conventional myeloablative (MA) regimens in various hematologic diseases including myeloid 1-9 and lymphoid 10,11 malignancies. In these studies, patients were mostly older than the typical allogeneic SCT recipients and those in the historical control group. [9][10][11][12] Despite this limitation, and the fact that no prospective comparisons between the NMA and MA approaches have been published to date, these studies have shown that NMA transplant may result in an acceptable outcome in patients with no other alternative. One common finding in these series is that the NMA approach reduces the duration of the initial neutropenic phase, 1,2 reduces blood transfusion requirements, 4,5,8 decreases transplant-related mortality, 9,13 and may even be used in an outpatient setting.14 Given these findings, the overall cost of the NMA procedure including drugs, blood products, and hospital resource utilization would be expected to be lower than the conventional treatment using MA conditioning, which usually requires at least 4 weeks of hospitalization compared to 0-3 weeks with the NMA approach. Considering the low transplant-related mortality of the procedure in several series, 4,5,8 the time has come to conduct prospective comparative studies between NMA and MA approaches in...

Cost-effectiveness and clinical outcomes of double versus single cord blood transplantation in adults with acute leukemia in France

“…There was no difference in the 1-year cost in Cordonnier's study, 34 whereas Saito et al 36 reported lower costs for patients receiving RIC than those given MAC: € 80,499 versus € 128,254, respectively. In our study, we also found a cost increase of approximately € 30,000 for patients receiving MAC.…”

“…More recent studies have estimated the 1-year cost of related and unrelated donor HSCT using bone marrow or peripheral blood stem cells as € 139,414 in Sweden 32 and € 128,800 in the USA. 33 Cordonnier et al 34 reported the total cost of HLA identical sibling HSCT after RIC and MAC in France. The cost for 1 year after HSCT was around € 60,000.…”

Reduced-intensity conditioning for acute myeloid leukemia: is this strategy correct

“…41 On the other hand, engraftment failure rates may be higher and tempo to develop an antileukemic effect may be slower, the latter a potentially catastrophic situation if the transplant is not undertaken when the patient's disease is in complete remission. The graft-versusleukemia effect may be disease-specific, for example, stronger in chronic myeloid leukemia and multiple myeloma when compared to AML and acute lymphoblastic leukemia.…”

“…Cordonnier et al 41 evaluated the financial costs in a small series for myeloablative versus nonmyeloablative transplants in AML patients ( Table 7). The initial hospitalization (mean days) was longer in the myeloablative group, but the nonmyeloablative group had more mean readmission days.…”

Lower costs associated with hematopoietic cell transplantation using reduced intensity vs high-dose regimens for hematological malignancy

“…Our findings contrast with a small study of 23 patients, where rates of relapse, complications and OS differed, but no difference in costs between the two groups was observed. 38 Several limitations of our study should be explained. First, this is a single-institution observational study with a median follow-up of 3 years for survivors.…”