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Economic Analysis

Economic analysis of unrelated allogeneic bone marrow transplantation: results from the randomized clinical trial of T-cell depletion vs unmanipulated grafts for the prevention of graft-versus-host disease

Bone Marrow Transplantation volume 36, pages 539–546 (2005)Cite this article

Summary:

Unrelated-donor marrow transplantation is a potential option for transplant candidates lacking a compatible related donor. The T-cell Depletion Study compared the 3-year disease-free survival for patients receiving T-cell-depleted (TCD) donor marrow (n=203) vs unmanipulated donor marrow with methotrexate and cyclosporine (M/C) (n=207). Hospital costs during index admission were documented with billing data, while hospital costs during subsequent 6-month follow-up were estimated from case report forms. Patients with index admission billing were included in the analysis (TCD=119, M/C=127). Total hospital length of stay (LOS) was similar across groups, with medians 47.0 days for TCD and 52.0 days for M/C (P=0.72). Total hospital costs were comparable, $145 115 vs $141 981 (P=0.63) for TCD and M/C, respectively. However, controlling for site and patient characteristics, TCD was associated with a 12.1% reduction in LOS for the index admission (95% CI −19.4%, −4.3%). Independent of treatment, HLA matching (6/6) was associated with an 8.6% (95% CI −17.4%, +1.2%) reduction in the index admission LOS, while cost was lower by 15.8% (95% CI −26.7%, −3.3%). Treatment costs were similar for TCD and M/C study groups. Savings on reduced cost for treating acute graft-versus-host disease were likely offset by increase in serious infections in the TCD arm.

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References

  1. Lee SJ, Anasetti C, Kuntz KM et al. The costs and cost-effectiveness of unrelated donor bone marrow transplantation for chronic phase chronic myelogenous leukemia. Blood 1998; 92: 4047–4052.

    CAS  Google Scholar 

  2. Lee SJ, Zahrieh D, Alyea EP et al. Comparison of T cell-depleted and non-T cell depleted unrelated donor transplantation for hematologic diseases: clinical outcomes, quality of life, and costs. Blood 2002; 100: 2697–2702.

    Article  CAS  Google Scholar 

  3. Wagner JE, Thompson JS, Carter SL, Kernan NA . Impact of graft-versus-host disease prophylaxis on 3-year disease-free survival in recipients of unrelated donor bone marrow (T cell Depletion Trial): results of a multi-center, randomized phase II–III trial. Lancet (in press).

  4. Drummond MF, Stoddart GL . Economic analysis and clinical trials. ControlClin Trials 1984; 5: 115–128.

    Article  CAS  Google Scholar 

  5. Bennett C, Waters T, Stinson T et al. Valuing clinical strategies early in development: a cost analysis of allogeneic peripheral blood stem cell transplantation. Bone Marrow Transplant 1999; 24: 555–560.

    Article  CAS  Google Scholar 

  6. US Department of Labor Bureau of Labor Statistics, Producer Price Index: General Medical and Surgical hospitals. Series ID pcu622110622110. http://data.bls.gov/cgi-bin/surveymostaccess (19 July 2004).

  7. Steiner C, Elixhauser A, Schnaier J . The healthcare cost and utilization project: an overview. Eff Clin Pract 2002; 5: 143–151.

    PubMed  Google Scholar 

  8. Kline RM, Meiman S, Tarantino MD et al. A detailed analysis of charges for hematopoietic stem cell transplantation at a children's hospital. Bone Marrow Transplant 1998; 21: 195–203.

    Article  CAS  Google Scholar 

  9. Manning WG, Mullahy J . Estimating logged models: to transform or not to transform. J Health Econ 2001; 20: 461–494.

    Article  CAS  Google Scholar 

  10. Garber AM, Weinstein GW, Torrance GW, Kamlet MS . Theoretical foundations of cost-effectiveness analysis. In: Gold MR, Siegel JE, Russell LB, Weinstein MC (eds.). Cost-effectiveness in Health and Medicine. Oxford University Press: New York, 1996 pp 28–29.

    Google Scholar 

  11. Waters TM, Bennett CL, Pajeau TS et al. Economic analyses of bone marrow and blood stem cell transplantation for leukemias and lymphoma: what do we know? Bone Marrow Transplant 1998; 21: 641–650.

    Article  CAS  Google Scholar 

  12. Altmaier EM, Ewell M, McQuellon R et al. The effect of unrelated-donor marrow transplantation on health-related quality of life: a report of the Unrelated Donor Marrow Transplantation Trial (T Cell Depletion Trial) (submitted for publication).

  13. van Agthoven M, Grott MT, Verdonck LF et al. Cost analysis of HLA-identical sibling and voluntary unrelated allogeneic bone marrow and peripheral blood stem cell transplantation in adults with acute myelocytic leukaemia or acute lymphoblastic leukaemia. Bone Marrow Transplant 2002; 30: 243–251.

    Article  CAS  Google Scholar 

  14. van Burik JH, Carter SL, Freifeld AG et al. Analysis of infectious complications after unrelated donor bone marrow transplantation: results of a prospective multi-center trial comparing T-cell depletion versus immune suppression therapy (submitted for publication).

  15. Sosa JA, Bowman HM, Gordon TA et al. Importance of hospital volume in the overall management of pancreatic cancer. Ann Surg 1998; 228: 429–438.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank the patients who willingly entered this large clinical trial, the physicians, nurses, and other support staff who cared for them during the transplant procedure, and the clinical investigation team at each participating institution for data collection and follow-up. We also thank the National Heart, Lung, and Blood Institute (NHLBI) for support of this trial. In addition to the authors, the following transplant centers, study physicians, and experts contributed to this study: University of Minnesota (N=103; John E Wagner, MD and Stella M Davies, MBBS, PhD), Memorial Sloan-Kettering Cancer Center (N=70; Esperanza Papadopoulos, MD, Richard O'Reilly, MD), Medical College of Virginia (N=53), Wake-Forest University-School of Medicine (N=36), University of Nebraska (N=34; Stephen Pavletic, MD, Michael Bishop, MD), University of Utah (N=33; Finn Bo Petersen, MD), Stanford University (N=25; Robert Negrin, MD), University of Iowa (N=19; Robert Gingrich, MD), University of South Carolina (N=13), Ohio State University (N=6; Edward Copelan, MD), Duke University (N=6; Joanne Kurtzberg, MD), University of Kentucky (N=5; John S Thompson, MD, Gordon Phillips, MD), Medical College of Wisconsin (N=4; James Casper, MD, Carolyn Keever-Taylor, MD, William Drobyski, MD, Neal Flomenberg, MD), Western Pennsylvania Hospital (N=2; Richard Shattuck, MD), and University of Pittsburgh (N=1; Albert Donnenberg, PhD), the EMMES Corporation (Donald Stablein, PhD, Adam Mendizabal, MS, Elizabeth Wagner, MPH), NHLBI (LeeAnn Jensen, PhD, Nancy Geller, PhD, Paul McCurdy, MD), MEDTAP International (Sandra Macker). This trial was supported by a contract from the National Heart, Lung and Blood Institute (N01-HB-47094 (GL, SLC and ME), N01-HB-47097 (DH, PB, JHD, and SY), N01-HB-47098 (NAK), and N01-HB-47095 (DW)).

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Authors and Affiliations

  1. MEDTAP International Incorporated, Bethesda, MD, USA

    G de Lissovoy

  2. Wake Forest University School of Medicine, Winston-Salem, NC, USA

    D Hurd

  3. The EMMES Corporation, Rockville, MD, USA

    S Carter & M Ewell

  4. University of Utah Medical Center, Salt Lake City, UT, USA

    P Beatty

  5. Division of Transplantation Medicine, University of South Carolina, Columbia, SC, USA

    J Henslee-Downey

  6. Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    N Kernan

  7. Medical College of Virginia, Richmond, VA, USA

    S Yanovich

  8. Department of Medicine, University of Minnesota, Minneapolis, MN, USA

    D Weisdorf

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  1. G de Lissovoy
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  2. D Hurd
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  7. N Kernan
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  8. S Yanovich
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  9. D Weisdorf
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Correspondence to G de Lissovoy.

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de Lissovoy, G., Hurd, D., Carter, S. et al. Economic analysis of unrelated allogeneic bone marrow transplantation: results from the randomized clinical trial of T-cell depletion vs unmanipulated grafts for the prevention of graft-versus-host disease. Bone Marrow Transplant 36, 539–546 (2005). https://doi.org/10.1038/sj.bmt.1705078

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