Article ; Online: Costs of matched-sibling, unrelated, and haploidentical hematopoietic cell transplantation and risk factors for greater financial burden - a Brazilian FACT-accredited single-center analysis.
2022 Volume 101, Issue 11, Page(s) 2507–2513
Abstract: The complexity and costs of hematopoietic cell transplantation (HCT) have increased over the last decades with the popularization of unrelated donor (URD) transplantation and the introduction of haploidentical transplantation with posttransplant ... ...
| Abstract | The complexity and costs of hematopoietic cell transplantation (HCT) have increased over the last decades with the popularization of unrelated donor (URD) transplantation and the introduction of haploidentical transplantation with posttransplant cyclophosphamide. Few studies have addressed this issue. The objective of this study was to analyze HCT costs in a single FACT-accredited private non-profit hospital. We included 79 patients who underwent HCT between 2018 and 2020. We have included all costs from admission day until D + 180. We used a lognormal regression. Median age was 53 y/o and most donors were unrelated (51%). Costs were higher with haploidentical donor (42%, p = 0.017, compared with URD), higher HCT-CI (15% for each point, p = 0.0056), and in patients with liver or gastrointestinal GVHD (45%, p = 0.033), and lower in patients who received CD34 > 2.5 × 10E6/kg (42%, p = 0.0038). We built a score based on the following risk factors: HCT-CI > 3, CD34 ≤ 2.5 × 10E6/kg, haploidentical donor, and donor age > 30 y/o. Patients with 2 + risk factors (N = 53) had a median cost of USD 226,156.00, compared with USD 93,048.00 in patients with zero or 1 point (N = 26, p < 0.0001). In summary, we have shown that HCT costs are higher with lower doses of CD34 cells, haploidentical HCT (provided that the costs of stem cell procurement and ATG are not included), and in patients with higher HCT-CI. Prospective and refined cost analyses comparing haploidentical and URD transplants, as well as effective strategies for patients with higher HCT-CI scores, are warranted. We found no difference in costs between URD and MSD transplantation. |
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| MeSH term(s) | Brazil ; Cyclophosphamide ; Financial Stress ; Graft vs Host Disease/etiology ; Graft vs Host Disease/prevention & control ; Hematopoietic Stem Cell Transplantation/adverse effects ; Humans ; Middle Aged ; Prospective Studies ; Retrospective Studies ; Risk Factors ; Siblings ; Transplantation Conditioning ; Unrelated Donors |
| Chemical Substances | Cyclophosphamide (8N3DW7272P) |
| Language | English |
| Publishing date | 2022-09-12 |
| Publishing country | Germany |
| Document type | Journal Article |
| ZDB-ID | 1064950-5 |
| ISSN | 1432-0584 ; 0939-5555 ; 0945-8077 |
| ISSN (online) | 1432-0584 |
| ISSN | 0939-5555 ; 0945-8077 |
| DOI | 10.1007/s00277-022-04971-z |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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