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Financial impact of post-transplant complications among children undergoing allogeneic hematopoietic cell transplantation

Bone Marrow Transplantation volume 55, pages 1421–1429 (2020)Cite this article

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Abstract

Complications following allogeneic hematopoietic cell transplantation (alloHCT) continue to be a significant challenge that often result in significant morbidity/mortality and increased healthcare utilization and cost. In this study, we analyzed the impact of post-alloHCT complications on healthcare utilization and cost during first year post-transplant. We analyzed data on 240 pediatric patients. Complications analyzed included kidney injury, liver injury, lung injury, viral infections, bacterial infections, fungal infections, and acute graft-versus-host disease (GVHD). Patients were divided into three groups based on the number of complications (0–1, 2–3, and >3). Cost was estimated from charges recorded in the Pediatric Health Information System database and hospital accounting records. Patients with >3 complications had higher healthcare utilization and cost, primarily driven by inpatient hospitalization and intensive care unit admissions. Multivariable analysis of risk factors identified bacteremia ($90,166, SE = 26,636, p < 0.001), lung injury ($108,529, SE = 28,196, p < 0.001), liver injury ($90,805, SE = 28,660, p = 0.002), and grade II–IV aGVHD ($137,866, SE = 28,472, p < 0.001) as associated with significantly increased cost. Our study highlights the significant impact complications have on the overall cost of alloHCT. The identification that complications associated with high morbidity (aGVHD, pulmonary disease) are also associated with the highest financial burden emphasizes the need for future research in these areas to expand management options and improve outcomes for our patients.

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Fig. 1: Incremental cost of complications during first year post-alloHCT.
Fig. 2: Financial impact of individual complications.

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Acknowledgements

We would also like to thank Stephanie Kjelleren Conner, MHSA, and Fisnik Prishtina for providing outpatient financial data.

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Authors and Affiliations

  1. Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Department of Pediatrics, Columbia University Medical Center, New York, NY, USA

    Angela Ricci, Larisa Broglie, Monica Bhatia, Laurie Davis, Diane George, James H. Garvin & Prakash Satwani

  2. Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA

    Zhezhen Jin

  3. Department of Pediatrics, Columbia University Medical Center, New York, NY, USA

    Wallace Bourgeois & Jenny Ruiz

  4. Children’s Hospital Association, Lenexa, KS, USA

    Matthew Hall

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  1. Angela Ricci
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Correspondence to Prakash Satwani.

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Ricci, A., Jin, Z., Bourgeois, W. et al. Financial impact of post-transplant complications among children undergoing allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 55, 1421–1429 (2020). https://doi.org/10.1038/s41409-020-0899-0

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