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Transplant Toxicities

Association of hematopoietic cell transplantation-specific comorbidity index with resource utilization after allogeneic transplantation

Bone Marrow Transplantation volume 52, pages 998–1002 (2017)Cite this article

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Abstract

Comorbidities affect clinical outcomes and costs in medicine. The hematopoietic cell transplantation (HCT)-specific comorbidity index (HCT-CI) predicts mortality risk after HCT. Its association with resource utilization (RU) is unknown. In this single-center, retrospective study, we examined the association of HCT-CI with RU (readmissions, length of hospital stay (LOS) and days out of hospital alive (DOHA)) in first 100 days (n=328) and 1 year (n=226) in allogeneic HCT patients from January 2010 to June 2014. Age, disease risk, conditioning and use of antithymocyte globulin were significantly different in the four groups with HCT-CI 0 to1 (n=138), 2 (n=56), 3 (n=55) or ⩾4 (n=79). Although the readmissions were higher in the first 100 days for patients with HCT-CI >0–1 (P=0.03), they were not significantly different in patients over 1 year (P=0.13). In the multivariable analysis, patients with HCT-CI score of >0 to 1 had increased LOS and fewer DOHA in both 100 days and 1 year after HCT. In this exploratory analysis, we found that HCT-CI >0 to 1 is associated with increased RU after allogeneic HCT. Recognizing predictors of RU can identify patients at risk of high utilization and help understand what drives health-care costs.

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References

  1. Khera N, Zeliadt SB, Lee SJ . Economics of hematopoietic cell transplantation. Blood 2012; 120: 1545–1551.

    Article  CAS  Google Scholar 

  2. Shulman DS, London WB, Guo D, Duncan CN, Lehmann LE . Incidence and causes of hospital readmission in pediatric patients after hematopoietic cell transplantation. Biol Blood Marrow Transplant 2015; 21: 913–919.

    Article  Google Scholar 

  3. Spring L, Li S, Soiffer RJ, Antin JH, Alyea Iii EP, Glotzbecker B . risk factors for readmission after allogeneic hematopoietic stem cell transplantation and impact on overall survival. Biol Blood Marrow Transplant 2015; 21: 509–516.

    Article  Google Scholar 

  4. Lee SJ, Klar N, Weeks JC, Antin JH . Predicting costs of stem-cell transplantation. J Clin Oncol 2000; 18: 64–71.

    Article  CAS  Google Scholar 

  5. Saito AM, Zahrieh D, Cutler C, Ho VT, Antin JH, Soiffer RJ et al. Lower costs associated with hematopoietic cell transplantation using reduced intensity vs high-dose regimens for hematological malignancy. Bone Marrow Transplant 2007; 40: 209–217.

    Article  CAS  Google Scholar 

  6. Kline RM, Meiman S, Tarantino MD, Herzig RH, Bertolone SJ Jr . 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 

  7. Griffiths RI, Bass EB, Powe NR, Anderson GF, Goodman S, Wingard JR . Factors influencing third party payer costs for allogeneic BMT. Bone Marrow Transplant 1993; 12: 43–48.

    CAS  PubMed  Google Scholar 

  8. Khera N, Emmert A, Storer BE, Sandmaier BM, Alyea EP, Lee SJ . Costs of allogeneic hematopoietic cell transplantation using reduced intensity conditioning regimens. Oncologist 2014; 19: 639–644.

    Article  Google Scholar 

  9. Lee SJ, Zahrieh D, Alyea EP, Weller E, Ho VT, Antin JH 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 

  10. Lin YF, Lairson DR, Chan W, Du XL, Leung KS, Kennedy-Nasser AA et al. The costs and cost-effectiveness of allogeneic peripheral blood stem cell transplantation versus bone marrow transplantation in pediatric patients with acute leukemia. Biol Blood Marrow Transplant 2010; 16: 1272–1281.

    Article  Google Scholar 

  11. Majhail NS, Mothukuri JM, Macmillan ML, Verneris MR, Orchard PJ, Wagner JE et al. Costs of pediatric allogeneic hematopoietic-cell transplantation. Pediatr Blood Cancer 2010; 54: 138–143.

    Article  Google Scholar 

  12. El-Jawahri A, Chen Y-B, Brazauskas R, He N, Lee SJ, Knight JM et al. Impact of pre-transplant depression on outcomes of allogeneic and autologous hematopoietic stem cell transplantation. Cancer (e-pub ahead of print 19 January 2017; doi:10.1002/cncr.30546).

  13. Sorror ML, Maris MB, Storb R, Baron F, Sandmaier BM, Maloney DG et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood 2005; 106: 2912–2919.

    Article  CAS  Google Scholar 

  14. Sorror M, Storer B, Sandmaier BM, Maloney DG, Chauncey TR, Langston A et al. Hematopoietic cell transplantation-comorbidity index and Karnofsky performance status are independent predictors of morbidity and mortality after allogeneic nonmyeloablative hematopoietic cell transplantation. Cancer 2008; 112: 1992–2001.

    Article  Google Scholar 

  15. Bayraktar UD, Shpall EJ, Liu P, Ciurea SO, Rondon G, de Lima M et al. Hematopoietic cell transplantation–specific comorbidity index predicts inpatient mortality and survival in patients who received allogeneic transplantation admitted to the intensive care unit. J Clin Oncol 2013; 31: 4207–4214.

    Article  Google Scholar 

  16. Charlson ME, Charlson RE, Peterson JC, Marinopoulos SS, Briggs WM, Hollenberg JP . The Charlson comorbidity index is adapted to predict costs of chronic disease in primary care patients. J Clin Epidemiol 2008; 61: 1234–1240.

    Article  Google Scholar 

  17. Hollenbeak CS, Stack BC Jr., Daley SM, Piccirillo JF . Using comorbidity indexes to predict costs for head and neck cancer. Arch Otolaryngol Head Neck Surg 2007; 133: 24–27.

    Article  Google Scholar 

  18. Starfield B, Lemke KW, Herbert R, Pavlovich WD, Anderson G . Comorbidity and the use of primary care and specialist care in the elderly. Ann Fam Med 2005; 3: 215–222.

    Article  Google Scholar 

  19. Landi F, Onder G, Cesari M, Barillaro C, Lattanzio F, Carbonin PU et al. Comorbidity and social factors predicted hospitalization in frail elderly patients. J Clin Epidemiol 2004; 57: 832–836.

    Article  Google Scholar 

  20. Ariti CA, Cleland JG, Pocock SJ, Pfeffer MA, Swedberg K, Granger CB et al. Days alive and out of hospital and the patient journey in patients with heart failure: Insights from the candesartan in heart failure: assessment of reduction in mortality and morbidity (CHARM) program. Am Heart J 2011; 162: 900–906.

    Article  Google Scholar 

  21. Armand P, Gibson CJ, Cutler C, Ho VT, Koreth J, Alyea EP et al. A disease risk index for patients undergoing allogeneic stem cell transplantation. Blood 2012; 120: 905–913.

    Article  CAS  Google Scholar 

  22. Stranges E, Russo CA, Friedman B . Procedures with the Most Rapidly Increasing Hospital Costs, 2004–2007. HCUP Statistical Brief #82. Agency for Healthcare Research and Quality: Rockville, MD, USA, 2009.

    Google Scholar 

  23. Lee SJ, Anasetti C, Kuntz KM, Patten J, Antin JH, Weeks JC . The costs and cost-effectiveness of unrelated donor bone marrow transplantation for chronic phase chronic myelogenous leukemia. Blood 1998; 92: 4047–4052.

    CAS  PubMed  Google Scholar 

  24. Majhail NS, Mothukuri JM, Brunstein CG, Weisdorf DJ . Costs of hematopoietic cell transplantation: comparison of umbilical cord blood and matched related donor transplantation and the impact of posttransplant complications. Biol Blood Marrow Transplant 2009; 15: 564–573.

    Article  Google Scholar 

  25. Sorror ML, Martin PJ, Storb RF, Bhatia S, Maziarz RT, Pulsipher MA et al. Pretransplant comorbidities predict severity of acute graft-versus-host disease and subsequent mortality. Blood 2014; 124: 287–295.

    Article  CAS  Google Scholar 

  26. Lee WC, Arcona S, Thomas SK, Wang Q, Hoffmann MS, Pashos CL . Effect of comorbidities on medical care use and cost among refractory patients with partial seizure disorder. Epilepsy Behav 2005; 7: 123–126.

    Article  Google Scholar 

  27. Hagenmeyer EG, Haussler B, Hempel E, Grannas G, Kalo Z, Kilburg A et al. Resource use and treatment costs after kidney transplantation: impact of demographic factors, comorbidities, and complications. Transplantation 2004; 77: 1545–1550.

    Article  Google Scholar 

  28. Stewart S, Wiley JF, Ball J, Chan Y-K, Ahamed Y, Thompson DR et al. Impact of nurse-led, multidisciplinary home-based intervention on event-free survival across the spectrum of chronic heart disease: composite analysis of health outcomes in 1226 patients from 3 randomized trials. Circulation 2016; 133: 1867–1877.

    Article  Google Scholar 

  29. Boriani G, Berti E, Belotti LMB, Biffi M, De Palma R, Malavasi VL et al. Cardiac device therapy in patients with left ventricular dysfunction and heart failure: ‘real-world’ data on long-term outcomes (mortality, hospitalizations, days alive and out of hospital). Eur J Heart Fail 2016; 18: 693–702.

    Article  Google Scholar 

  30. Hasan O, Meltzer DO, Shaykevich SA, Bell CM, Kaboli PJ, Auerbach AD et al. Hospital readmission in general medicine patients: a prediction model. J Gen Intern Med 2010; 25: 211–219.

    Article  Google Scholar 

  31. Bejanyan N, Bolwell BJ, Lazaryan A, Rybicki L, Tench S, Duong H et al. Risk factors for 30-day hospital readmission following myeloablative allogeneic hematopoietic cell transplantation (allo-HCT). Biol Blood Marrow Transplant 2012; 18: 874–880.

    Article  Google Scholar 

  32. Cordonnier C, Maury S, Esperou H, Pautas C, Beaune J, Rodet M et al. Do minitransplants have minicosts? A cost comparison between myeloablative and nonmyeloablative allogeneic stem cell transplant in patients with acute myeloid leukemia. Bone Marrow Transplant 2005; 36: 649–654.

    Article  CAS  Google Scholar 

  33. Khera N, Emmert A, Storer BE, Sandmaier BM, Alyea EP, Lee SJ . Costs of allogeneic hematopoietic cell transplantation using reduced intensity conditioning regimens. Oncologist 2014; 19: 639–644.

    Article  Google Scholar 

  34. Petersen SL, Madsen HO, Ryder LP, Svejgaard A, Jakobsen BK, Sengeløv H et al. Haematopoietic stem cell transplantation with non-myeloablative conditioning in the outpatient setting: results, complications and admission requirements in a single institution. Br J Haematol 2004; 125: 225–231.

    Article  Google Scholar 

  35. Deeg H, Steuten LM . Therapy for hematologic cancers in older patients, quality of life, and health economics: Difficult decisions. JAMA Oncol 2015; 1: 571–572.

    Article  Google Scholar 

Download references

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Authors and Affiliations

  1. Department of Hematology/Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA

    L Decook, J Slack, D Gastineau, J Leis, P Noel, J Palmer, L Sproat & N Khera

  2. Department of Biostatistics, Mayo Clinic Arizona, Phoenix, AZ, USA

    Y-H Chang

  3. Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    M Sorror

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  1. L Decook
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  2. Y-H Chang
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Correspondence to N Khera.

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Decook, L., Chang, YH., Slack, J. et al. Association of hematopoietic cell transplantation-specific comorbidity index with resource utilization after allogeneic transplantation. Bone Marrow Transplant 52, 998–1002 (2017). https://doi.org/10.1038/bmt.2017.70

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