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The Costs And Cost-Effectiveness Of Allogeneic Peripheral Blood Stem Cell Transplantation Versus Bone Marrow Transplantation In Pediatric Patients With Acute Leukemia

Year: 2010

Type: article

Abstract: In a retrospective study, we evaluated the cost and cost-effectiveness of allogeneic peripheral blood stem cell transplantation (PBSCT) (n=30) compared with bone marrow transplantation (BMT) (n=110) in children with acute leukemia at 1 year of follow up. Treatment success was defined as disease free survival at one year post transplant. The inpatient days (42.9 d for PBSCT; 36.8 d for BMT) and costs from day of admission to transplantation to day of discharge ($282,577 for PBSCT; $208,987 for BMT) were not significantly different between these two groups during the initial hospitalization for transplantation. From the initial hospitalization to 100 days post transplant, the PBSCT group cost was $147,906 compared to $103,428 for the BMT group (P=NS). From 100 days post transplant to 1 year, PBSCT cost was $106,683 compared to $124,578 for BMT (P=NS). For standard risk disease patients the treatment success rate was 57.1% for PBSCT patients and 80.3% for recipients of BMT (P=NS). The average total cost per treatment success at 1 year in the standard risk disease group was $512,294 for the PBSCT group and $352,885 for the BMT group (P=NS). For patients with high risk disease, the treatment success rate was 18.8% for PBSCT patients and 23.5% for BMT (P=NS). The cumulative average cost for patients in the BMT group was $457,078 compared to $377,316 for PBSCT (P=NS). Point estimates of the incremental cost-effectiveness ratio (ICER) indicate that allogeneic transplantation of bone marrow grafts is dominant over PBSCT for its lower costs and higher effectiveness in patients with standard risk disease (ICER=-$687,108; 95% CI=$2.4 million to dominated). For patients with high risk disease, BMT was more effective and more costly and the ICER was $1.69 million (95% CI=$29.7 million to dominated) per additional treatment success. The comparative economic evaluation provides support for BMT for standard risk patients, but the large degree of uncertainty precludes definite support for either treatment option in patients with high risk disease.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2009.12.339