In adult patients who need an allogeneic hematopoietic cell transplant (alloHCT), haploidentical related donor transplants (haploHCTs) could result in cost savings and might be preferred for patients with limited resources compared with double umbilical cord blood transplants (dUCBTs), according to data published in Biology of Blood and Marrow Transplantation.
Alternative donor sources for alloHCT are safe and effective for adult patients with no human leukocyte antigen (HLA)-identical siblings or unrelated donors, and most transplant centers rely on haploHCT or dUCBT for patients with these needs.
Because of the absence of published, randomized data directly comparing outcomes and cost effectiveness between haploHCT and dUCBT, researchers retrospectively assessed the costs and expenses of haploHCT and dUCBT in the 100 days following alloHCT. Data from 49 patients who underwent haploHCT and 37 patients who underwent dUCBT were included in the analysis.
The authors noted that baseline patient characteristics were not well balanced between the 2 groups. For example, patients in the haploHCT group had a median age of 55 years, compared with a median age of 44 years in the dUCBT group (P =.02). Though the conditioning regimen was primarily fludarabine- and cyclophosphamide-based for both groups, no patients undergoing haploHCT received antithymocyte globulin in their conditioning regimen, while 78% of patients undergoing dUCBT did.
Comparisons of graft acquisition costs, inpatient and outpatient charges, and total charges in the 100 days following transplant indicated that haploHCT was associated with a significantly lower cost of graft acquisition and lower total charges compared with dUCBT. Graft acquisition cost a median of $35,000 (range, $7000-$69,000) in the haploHCT group and a median of $88,000 (range, $42,000-$135,000) in the dUCBT group (P <.001).
When total cost analysis was limited to patients still alive at 100 days post-transplant, haploHCT cost $80,000 less than dUCBT ($515,000 vs $595,000; P =.02). Researchers controlled for cost variation between centers by making adjustments based on the 2018 local wage index and inflation rate.
The authors suggested a prospective, randomized study could better elucidate the potential cost differences and survival outcomes between these alternative alloHCT approaches, though preliminary data suggest a financial benefit to haploHCT.
1. Kanate AS, Szabo A, Raj RV, et al. Comparison of graft-acquisition and early direct charges of haploidentical related donor transplantation versus umbilical cord blood transplantation [published online March 13, 2019]. Biol Blood Marrow Transplant. doi: 10.1016/j.bbmt.2019.03.013