Patients with hematologic malignancies undergoing inpatient allogeneic hematopoietic cell transplantation (allo-HCT) experienced significant health resource use and costs following allo-HCT, according to research presented at the 2022 Tandem Meetings.
The researchers quantified the total costs (payer adjudicated paid amount, adjusted to 2020 USD) of care during the pre-transplant period (14 days prior to allo-HCT) and the post-transplant period (up to 100 days), assessed real-world complication rates, and defined specific cost drivers for allo-HCT among patients with hematologic malignancies covered under commercial insurance in the United States.
The team used the IBM MarketScan Commercial Claims and Encounters Database (2016 Q1-2020 Q2) to identify data of patients aged 12–64 years with hematologic malignancy undergoing inpatient allo-HCT. For inclusion in the study, patients were required to be continuously enrolled in a health plan for ≥6 months before and ≥1 month after HCT. The researchers defined primary hospitalization as the time from transplant procedure until the first discharge date and used medical billing codes to estimate the incidence of complications from the date of the transplant procedure up to 100 days post-HCT.
A total of 1082 recipients of allo-HCT met the study inclusion criteria. Patients had a mean age of 48 years and 57% of the patients were male. The most common malignances were acute myeloid leukemia (43%), myelodysplastic syndrome (16%), acute lymphocytic leukemia (15%), and lymphoma (12%). Specified types of allo-HCT grafts included peripheral blood (79%), bone marrow (11%) and umbilical cord blood (3%).
All patients were hospitalized on the day of the allo-HCT. Following the procedure, 31% of patients had readmission within 100 days post-HCT. The mean primary hospitalization length of stay (LOS) was 32.4 days. During the transplant period (114 days), 44% of patients had an intensive care unit (ICU) admission or level of care (indicated by revenue codes). The mean ICU LOS was 31.3 days. Patients also had a mean number of 27.3 outpatient visits, and 16% of patients had ≥1 emergency room (ER) visit.
During the full-transplant period, the per-patient mean all-cause health care cost was $407,600, attributed predominantly to the primary hospitalization (mean cost, $293,000). Other costs included inpatient readmissions (mean cost, $34,500), the conditioning period ($33 000), outpatient/ER/Other ($33,000), and outpatient pharmacy ($15,000). Overall, 80% of the full transplant-related costs were attributed to hospitalization.
During the post-transplant period, 52% of patients had acute graft-versus-host disease, and 21% of patients had cytomegalovirus infection. Other common (≥20%) complications included bacterial infection (45%), mucositis (30%), malignant relapse (24%), and acute renal failure (23%).
“Novel therapies for hematologic malignancies that reduce the need for extended inpatient care with lower rates of complications may significantly reduce total cost of care in this population,” the researchers wrote in their abstract.
Limitations of the study included potential errors in record diagnostic and procedure codes for reimbursement purposes in the claims databases and unavailability of clinical diagnoses, or measures of disease severity, beyond those resulting in specific billing codes.
Disclosure: This research was supported by Gamida Cell. Please see the original reference for a full list of disclosures.
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Maziarz RT, Edwards ML, Gergis U, et al. Total costs of care and complication rates among patients with hematologic malignancies who receive allogeneic hematopoietic cell transplants in the US. Presented at: 2022 Tandem Meetings; April 23-26, 2022. Abstract 334.