Costs of second allogeneic hematopoietic cell transplantation

Abstract

Graft failure, disease recurrence and secondary malignancy are the main indications for a second allogeneic transplant following a prior allogeneic (allo-allo) or autologous (auto-allo) hematopoietic cell transplantation (HCT). Reported outcomes are generally poor, especially for the allo-allo group. The role of planned tandem auto-allo transplants for myeloma and lymphoma is continuing to evolve. Our objective was to describe the cost profile of second HCT and evaluate the relationship between total costs, baseline patient characteristics and post-transplant complications. Clinical information and medical costs of 245 patients (allo-allo: 55, auto-allo: 190) who underwent a second HCT at Fred Hutchinson Cancer Research Center between 2004 and 2010 were collected. Linear regression was used to evaluate the associations between baseline patient characteristics, clinical events and costs for the first 100 days after transplantation. Median costs of the second allogeneic HCT were $151,000 (range $62,000-405,000) for the allo-allo group and $109,000 (range $26,000-490,000) for the auto-allo; there was no difference between the costs in the auto-allo group whether done as a planned tandem or as salvage for relapse. Median length of hospital stay was 23 days (range 0 - 76) for the allo-allo group and 9 days (range 0-96) for the auto-allo group. While HCT for graft failure in the allo-allo group and the use of myeloablative conditioning and unrelated or mismatched donors emerged as a significant predictor of costs in the auto-allo group when only pre-transplantation variables were considered, the year of transplant and post-transplant complications were significantly associated with costs in both groups when the post-transplant events were added to the model. Our results suggest that second allogeneic HCT is costly, particularly if it follows a prior allogeneic transplant, and is driven by the costs of complications.