1. ¹MEDTAP International Incorporated, Bethesda, MD, USA
2. ²Wake Forest University School of Medicine, Winston-Salem, NC, USA
3. ³The EMMES Corporation, Rockville, MD, USA
4. ⁴University of Utah Medical Center, Salt Lake City, UT, USA
5. ⁵Division of Transplantation Medicine, University of South Carolina, Columbia, SC, USA
6. ⁶Memorial Sloan-Kettering Cancer Center, New York, NY, USA
7. ⁷Medical College of Virginia, Richmond, VA, USA
8. ⁸Department of Medicine, University of Minnesota, Minneapolis, MN, USA

Correspondence: Dr G de Lissovoy, MEDTAP International Incorporated, Center of Health Economics, 7101 Wisconsin Avenue, Suite 600, Bethesda, MD 20814, USA. E-mail: deLissovoy@medtap.com

Received 12 January 2005; Accepted 25 May 2005; Published online 25 July 2005.

Abstract

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.