Reduced charges and costs associated with outpatient autologous stem cell transplantation

Abstract

Summary:High-dose chemotherapy and stem cell rescue is increasingly being delivered in the outpatient setting. Such intensive outpatient management programs have reduced the total hospital length of stay without compromising clinical outcomes. However, a detailed financial analysis of outpatient programs has not been performed. These data are the results of a prospective study of 94 patients receiving high-dose chemotherapy and autologous peripheral blood stem cell transplant in one of three settings: traditional inpatient, partial outpatient, total outpatient. Patients were allowed to choose their own treatment setting based upon the availability of a caregiver and personal preference. Total hospital length of stay and the actual cost and charges for each patient were monitored prospectively. The patients in the three groups were well balanced with regard to age and functional status prior to high-dose chemotherapy. The average length of stay was reduced from 17.3 to 8.2 to 2.7 days in the three different treatment settings (P Ͻ 0.01). Mean procedure costs were reduced from $39.7 thousand (US dollars) to $36.2 thousand to $29.4 thousand in the three treatment settings (P Ͻ 0.029). No differences in toxicity or overall response to therapy was noted. High-dose chemotherapy and stem cell rescue can be safely administered in the outpatient setting and results in significant cost savings. Keywords: bone marrow transplantation; costs; outpatient transplantation; charges High-dose chemotherapy with autologous stem cell rescue (HDC/ASCR) has become an increasingly utilized therapy for a wide variety of malignant diseases. HDC/ASCR has attracted a high level of scrutiny due to the high charges and costs associated with the procedure. Indeed, in the United States it is common for this procedure to require third-party and even fourth-party review before being approved by insurers. 1 Among the reasons for the high costs of HDC/ASCR is the prolonged hospitalization traditionally required for this treatment. Even with the use of hematopoietic growth factors and mobilized blood progenitor cells, which have shortened neutropenia and allowed earlier hospital discharge, hospital stays of 16 to more than 30 days are typical. 2,3,4 Peters and colleagues, 5 at Duke University Medical Center, pioneered a structured outpatient bone marrow transplant program wherein patients received all their highdose chemotherapy as inpatients and then were discharged to a 7-day-a-week outpatient clinic located a short distance from the main hospital. These patients had stage 2-4 breast cancer and received a high-dose chemotherapy regimen which did not induce a significant rate of mucositis, esophagitis or enteritis. In that program, all outpatients were housed in a local hotel adjacent to the outpatient clinic. In 1993, the Scripps Clinic stem cell transplant program advanced this model to include patients with diseases other than breast cancer receiving other chemotherapy regimens with a higher incidence of mucositis. 6 Subsequently we developed a...

Outpatient myeloablative allo-SCT: a comprehensive approach yields decreased hospital utilization and low TRM

“…Although a potential for cost savings exists, it is more difficult to show, as much of the in-patient cost reduction is simply shifted to the outpatient setting. 19 However, several studies have documented a 25-45% decrease in total medical charges associated with an outpatient management strategy 4,9,14,19 that could translate into substantial savings if applied to a significant proportion of more than 15 000 patients receiving HSCT in North America each year (data from the Center for International Blood and Marrow Transplant Research).…”

“…Since the early 1990s, there have been several published reports of successful outpatient-based autologous HSCT. [7][8][9][10][11][12][13][14][15] The experience with outpatient management of allogeneic HSCT has been quite limited outside the context of nonmyeloablative HSCT. [16][17][18] The group at John Hopkins reported on an in-patient-outpatient continuumof-care model for both autologous and allogeneic HSCT that resulted in a substantial cost savings, particularly in patients with standard risk disease, without an increase in clinical complications.…”

“…Several groups have shown that autologous HSCT can be safely delivered in the outpatient setting with good outcomes and diminished cost. [7][8][9][10][11][12][13][14][15] In addition, allogeneic transplantation after nonmyeloablative conditioning also seems feasible in the ambulatory care setting, [16][17][18] given its significantly reduced regimen-related toxicities compared with standard allogeneic HSCT. A few pilot studies have explored the safety of outpatient myeloablative allogeneic HSCT 4,19 in small numbers of selected patients, but none have documented whether this approach is generalizable to the majority of patients requiring such therapy.…”

Performing allogeneic and autologous hematopoietic SCT in the outpatient setting: effects on infectious complications and early transplant outcomes

“…3,4 A growing number of studies showing the feasibility, safety and cost reduction of OP auto-HSCT in patients with hematological malignancies have led to an increased acceptance of this approach. [5][6][7][8] However, extension of this model into the allogeneic (allo)-HSCT transplant population has not occurred. An early publication by Russell et al 9 described 50 consecutive patients receiving an allo-HSCT, nursed in a single room that included a subset of patients who were allowed to go home during their neutropenic phase.…”

Italian consensus conference for the outpatient autologous stem cell transplantation management in multiple myeloma

“…7-9 The significant increase in the waiting lists generated concerns about the appropriate use of health care resources and, over the past years, some studies have investigated the safety, efficacy and potential cost advantages of reducing hospital stay for patients undergoing ASCT. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] The ease of administering HDM, the relatively low extra-hematological toxicity and the short period of neutropenia 5,6 make MM patients ideal candidates for outpatient ASCT programs. Standardization of criteria for the outpatient ASCT policy is a relevant goal of the Italian hematology and transplant community and may facilitate comparison of retrospective and prospective data.…”