Patients receiving allogeneic hematopoietic stem cell transplantation (HSCT) face an average of $1 million in transplant-related costs throughout their lifetimes, and roughly half of those costs are associated with chronic graft-versus-host disease (GVHD) treatment, according to a new study.
Richard T. Maziarz, MD, of the Knight Cancer Institute at the Oregon Health and Science University, and colleagues conducted the study and presented their findings at the 64th American Society of Hematology Annual Meeting and Exposition.
Allogeneic HSCT management has “evolved with the emergence of molecular detection assays and therapies to treat post-HSCT complications such as [GVHD],” yet this approach “could increase the economic burden on health care systems by only managing complications that occur after the initial transplant,” Dr. Maziarz and colleagues wrote.
They conducted the study to estimate the average total lifetime medical costs of allogeneic HSCT and estimate the net monetary savings and value associated with reducing late complications from transplant. The researchers developed a 100-day short-term decision tree and a long-term, semi-Markov, partitioned survival model to estimate the average lifetime cost per patient and expected quality-adjusted life years for patients receiving allogeneic HSCT “from a United States health care system perspective,” Dr. Maziarz and colleagues wrote.
They studied a patient population that “represented an average 53-year-old patient” who was undergoing an allogeneic HSCT to treat the “most common indications” for it, which were , acute myeloid leukemia, acute lymphoblastic leukemia, or myelodysplastic syndrome, distributed as 51%, 21%, and 28%, respectively. The key outcomes of the study were direct medical costs and expected quality-of-life-adjusted years.
The model estimated the average per-patient medical cost of allogeneic HSCT over a lifetime would range from $942,373 to $1,247,917. Roughly half (range, 42%-56%) of the total costs were incurred within the first year after transplant, and nearly a third (range, 23%-30%) of the total costs were incurred within the first 100 days after transplant.
Chronic GVHD accounted for a larger proportion (range, 37%-53%) of those costs than the transplant procedure, which accounted for 15%-19% of total costs.
The model estimated that patients who underwent allogeneic HSCT had approximately 4.7 expected lifetime quality-adjusted life years.
“The current per-patient cost of [allogeneic HSCT] carries a substantial medical cost burden often exceeding $1 [million] over the lifetime of the patient,” Dr. Maziarz and colleagues concluded. “Innovative research efforts focused on disease control and reduction or elimination of late complications altogether, particularly [chronic] GVHD, may provide the greatest value in improved patient outcomes and reduced health care spending.”
Maziarz RT, Devine SM, Garrison LP, et al. Estimating the lifetime medical cost burden of an allogeneic hematopoietic cell transplantation patient and the value of addressing the unmet need. Abstract #4865. Presented at the 64th ASH Annual Meeting and Exposition; December 10-13, 2022; New Orleans, Louisiana.