Economics of hematopoietic cell transplantation

Khera, Nandita; Zeliadt, Steven B.; Lee, Stephanie J.

doi:10.1182/blood-2012-05-426783

Cited by 145 publications

(96 citation statements)

References 62 publications

(76 reference statements)

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“…The costs may also depend on the patient selection, being increased for individuals with high risk for treatment failure [16]. Marked differences between costs of alloHCT from sibling donors have been reported between countries (e.g., $148,709 [initial hospitalization] in the U.S. compared with $17,914 in India) [17,18]. These data may reflect lower personnel and infrastructural costs in less developed countries but also limited access to some expensive components of the procedure, including drugs and laboratory diagnostics.…”

Section: Discussionmentioning

confidence: 99%

Association of Macroeconomic Factors With Nonrelapse Mortality After Allogeneic Hematopoietic Cell Transplantation for Adults With Acute Lymphoblastic Leukemia: An Analysis From the Acute Leukemia Working Party of the EBMT

et al. 2016

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Acute lymphoblastic leukemia x Non-relapse mortality ABSTRACT Purpose. From a global perspective, the rates of allogeneic hematopoietic cell transplantation (alloHCT) are closely related to the economic status of a country. However, a potential association withoutcome hasnot yet been documented.The goal ofthis study was to evaluate effects of health care expenditure (HCE), Human Development Index (HDI),team density, and center experience on nonrelapsemortality(NRM)afterHLA-matchedsiblingalloHCTfor adults with acute lymphoblastic leukemia (ALL). Patients and Methods. A total of 983 patients treated with myeloablative alloHCT between 2004 and 2008 in 24 European countries were included. Results. In a univariate analysis, the probability of day 100 NRM was increased for countries with lower current HCE (8% vs. 3%; p 5 .06), countries with lower HDI (8% vs. 3%; p 5 .02), and centers with less experience (8% vs. 5%; p 5 .04). In addition, the overall NRM was increased for countries with lower current HCE (21% vs. 17%; p 5 .09) and HDI (21% vs. 16%; p 5 .03) and for centers with loweractivity (21% vs. 16%;p 5 .07). In a multivariate analysis,the strongest predictive model for day 100 NRM included current HCE greater than the median (hazard ratio [HR], 0.39; p 5 .002).The overall NRM was mostly predicted by HDI greater than the median (HR, 0.65; p 5 .01). Both lower current HCE and HDI were associated with decreased probability of overall survival. Conclusion. Both macroeconomic factors and the socioeconomic status of a country strongly influence NRM after alloHCT for adults with ALL. Our findings should be considered when clinical studies in the field of alloHCT are interpreted. The Oncologist 2016;21:377-383 Implications for Practice: Results of allogeneic hematopoietic cell transplantation (alloHCT) and other advanced oncological procedures may vary among countries and be related to various economic factors.This study, which included a homogenous population of patients with acute lymphoblastic leukemia, demonstrated significant associations of health care expenditure and the Human Development Index with nonrelapse mortality and overall survival after transplantation.The findings should be taken into account when clinical studies in the field of alloHCT are interpreted. The study should be followed by further investigation in other fields of oncology.

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Section: Discussionmentioning

confidence: 99%

Association of Macroeconomic Factors With Nonrelapse Mortality After Allogeneic Hematopoietic Cell Transplantation for Adults With Acute Lymphoblastic Leukemia: An Analysis From the Acute Leukemia Working Party of the EBMT

et al. 2016

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“…79,80 BMT survivors who develop chronic GVHD Table 1. Steps to ensure successful transition of pediatric and AYA BMT survivors into adult healthcare…”

Section: Infertility Resourcesmentioning

confidence: 99%

Childhood to adult transition and long-term follow-up after blood and marrow transplantation

Cupit

Duncan

Savani

et al. 2015

Bone Marrow Transplant

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The use of hematopoietic stem cell transplantation or blood and marrow transplantation (BMT) is on the increase worldwide. With BMT's increasing utilization and increasing success, the number of BMT survivors in the United States alone is expected to surpass 500 000 by the year 2030. BMT survivors are susceptible to a host of long-term side effects and complications. The pediatric and adolescent and young adult (AYA) populations comprise an increasing proportion of BMT survivors. Though these populations are both at risk of a specific set of sequelae and faced with the additional challenge of transitioning to adult care, no previous literature has addressed their specific challenges. In this review, we illustrate with clinical vignettes the need for focused and specific survivorship clinics for pediatric/AYA BMT survivors. We then focus on the following areas pertaining to pediatric BMT survivorship and care: (1) psychological health, (2) neurocognition, (3) endocrine health, (4) infertility resources, (5) issues in transition from pediatric to adult clinicians, (6) preventative services and (7) cost of care issues.

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“…5 Additional barriers to accessing HCT include variation in physicians' referral patterns, 15 the availability of a suitable transplant donor for allogeneic HCT, 16 and securing payment for treatment via insurance coverage pre-approval or patient prepayment. 17 Our analysis did not include differences in hematologic disease incidence rates or HCT service needs among subpopulations. To overcome this limitation, we provide demographic breakdowns by level of geographic access.…”

Section: Discussionmentioning

confidence: 99%

Geographic access to hematopoietic cell transplantation services in the United States

Delamater

Uberti

2015

Bone Marrow Transplant

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The use of hematopoietic cell transplantation (HCT) has risen in recent years and additional increases are projected in the near-and long-term future. The complex nature of HCT, along with its potentially rigorous follow-up care requirements, presents numerous potential barriers to accessing this important service (for example, financial considerations, donor availability and sociodemographic factors). The distance between a patient and an HCT facility also appears to be an important factor in both HCT use and outcomes. We provide the first comprehensive and detailed evaluation of geographic access to HCT services for the adult (18+ years) and pediatric (0-17 years) populations in the United States. Population-level access is examined as well as detailed gender, race/ethnicity and age breakdowns. Generally, access to HCT services appears to be quite high throughout the United States, as 48%, 78.6% and 94.7% of the 18+ years age population has 30, 90 and 180 min access (respectively) to an adult HCT facility and 42.5%, 72% and 91.5% of the 0-17 years age population has 30, 90 and 180 min access (respectively) to a pediatric facility.

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Economics of hematopoietic cell transplantation

Cited by 145 publications

References 62 publications

Association of Macroeconomic Factors With Nonrelapse Mortality After Allogeneic Hematopoietic Cell Transplantation for Adults With Acute Lymphoblastic Leukemia: An Analysis From the Acute Leukemia Working Party of the EBMT

Association of Macroeconomic Factors With Nonrelapse Mortality After Allogeneic Hematopoietic Cell Transplantation for Adults With Acute Lymphoblastic Leukemia: An Analysis From the Acute Leukemia Working Party of the EBMT

Childhood to adult transition and long-term follow-up after blood and marrow transplantation

Geographic access to hematopoietic cell transplantation services in the United States

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