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Mau LW, Meyer C, Burns LJ, Saber W, Steinert P, Vanness DJ, Preussler JM, Silver A, Leppke S, Murphy EA, Denzen E. Reimbursement, Utilization, and 1-Year Survival Post-Allogeneic Transplantation for Medicare Beneficiaries With Acute Myeloid Leukemia. JNCI Cancer Spectr 2019; 3:pkz048. [PMID: 31750417 PMCID: PMC6845850 DOI: 10.1093/jncics/pkz048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/21/2019] [Accepted: 07/08/2019] [Indexed: 12/18/2022] Open
Abstract
Background The economics of allogeneic hematopoietic cell transplantation (alloHCT) for older patients with acute myeloid leukemia (AML) affects clinical practice and public policy. To assess reimbursement, utilization, and overall survival (OS) up to 1 year post-alloHCT for Medicare beneficiaries aged 65 years or older with AML, a unique merged dataset of Medicare claims and national alloHCT registry data was analyzed. Methods Patients diagnosed with AML undergoing alloHCT from 2010 to 2011 were included for a retrospective cohort analysis with generalized linear model adjustment. One-year post-alloHCT reimbursement included Medicare, secondary payer, and beneficiary copayments (no coinsurance) (inflation adjusted to 2017 dollars). Cost-to-charge ratios were applied to estimate department-specific inpatient costs. Cox proportional hazards regression models were utilized to identify risk factors of 1-year OS post-alloHCT. Results A total of 250 patients met inclusion criteria. Mean total reimbursement was $230 815 (95% confidence interval [CI] = $214 381 to $247 249) 1 year after alloHCT. Pharmacy was the most- costly inpatient service category. Adjusted mean total reimbursement was statistically higher for patients who received cord blood grafts (P = .01), myeloablative conditioning (P < .0001), and alloHCT in the Northeast and West (P = .03). Mortality increased with age (hazard ratio [HR] = 1.08, 95% CI = 1.0 to 1.17), poorer Karnofsky performance score (<90% vs ≥90%, HR = 1.60, 95% CI = 1.08 to 2.35), and receipt of myeloablative conditioning (HR = 1.88, 95% CI = 1.21 to 2.92). Conclusions This merged dataset allowed adjustment for a richer set of patient- and HCT-related characteristics than claims data alone. The finding that nonmyeloablative conditioning was associated with lower reimbursement and improved OS 1 year post-alloHCT warrants further investigation.
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Affiliation(s)
- Lih-Wen Mau
- See the Notes section for the full list of authors' affiliations
| | - Christa Meyer
- See the Notes section for the full list of authors' affiliations
| | - Linda J Burns
- See the Notes section for the full list of authors' affiliations
| | - Wael Saber
- See the Notes section for the full list of authors' affiliations
| | | | - David J Vanness
- See the Notes section for the full list of authors' affiliations
| | | | - Alicia Silver
- See the Notes section for the full list of authors' affiliations
| | - Susan Leppke
- See the Notes section for the full list of authors' affiliations
| | | | - Ellen Denzen
- See the Notes section for the full list of authors' affiliations
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Is There a Place for Hematopoietic Stem Cell Transplantation in Rheumatology? Rheum Dis Clin North Am 2019; 45:399-416. [DOI: 10.1016/j.rdc.2019.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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What is the Role of Hematopoietic Cell Transplantation (HCT) for Pediatric Acute Lymphoblastic Leukemia (ALL) in the Age of Chimeric Antigen Receptor T-Cell (CART) Therapy? J Pediatr Hematol Oncol 2019; 41:337-344. [PMID: 30973486 DOI: 10.1097/mph.0000000000001479] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
CD19 chimeric antigen receptor T-cell (CART) therapy has revolutionized the treatment of patients with relapsed/refractory hematologic malignancies, especially B-cell acute lymphoblastic leukemia. As CART immunotherapy expands from clinical trials to FDA-approved treatments, a consensus among oncologists and hematopoietic cell transplant (HCT) physicians is needed to identify which patients may benefit from consolidative HCT post-CART therapy. Here, we review CD19 CART therapy and the outcomes of published clinical trials, highlighting the use of post-CART HCT and the pattern of relapse after CD19 CART. At this time, the limited available long-term data from clinical trials precludes us from making definitive HCT recommendations. However, based on currently available data, we propose that consolidative HCT post-CART therapy be considered for all HCT-eligible patients and especially for pediatric patients with KMT2A-rearranged B-cell acute lymphoblastic leukemia.
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Bewersdorf JP, Shallis RM, Wang R, Huntington SF, Perreault S, Ma X, Zeidan AM. Healthcare expenses for treatment of acute myeloid leukemia. Expert Rev Hematol 2019; 12:641-650. [DOI: 10.1080/17474086.2019.1627869] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Jan Philipp Bewersdorf
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Rory M. Shallis
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Rong Wang
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, School of Public Health, Yale University, New Haven, CT, USA
| | - Scott F. Huntington
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT, USA
| | - Sarah Perreault
- Department of Pharmacy, Yale New Haven Hospital, New Haven, CT, USA
| | - Xiaomei Ma
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, School of Public Health, Yale University, New Haven, CT, USA
| | - Amer M. Zeidan
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT, USA
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Lin JK, Muffly LS, Spinner MA, Barnes JI, Owens DK, Goldhaber-Fiebert JD. Cost Effectiveness of Chimeric Antigen Receptor T-Cell Therapy in Multiply Relapsed or Refractory Adult Large B-Cell Lymphoma. J Clin Oncol 2019; 37:2105-2119. [PMID: 31157579 DOI: 10.1200/jco.18.02079] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Two anti-CD19 chimeric antigen receptor T-cell (CAR-T) therapies are approved for diffuse large B-cell lymphoma, axicabtagene ciloleucel (axi-cel) and tisagenlecleucel; each costs $373,000. We evaluated their cost effectiveness. METHODS We used a decision analytic Markov model informed by recent multicenter, single-arm trials to evaluate axi-cel and tisagenlecleucel in multiply relapsed/refractory, adult, diffuse large B-cell lymphoma from a US health payer perspective over a lifetime horizon. Under a range of plausible long-term effectiveness assumptions, each therapy was compared with salvage chemoimmunotherapy regimens and stem-cell transplantation. Main outcomes were undiscounted life years, discounted lifetime costs, discounted quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (3% annual discount rate). Sensitivity analyses explored uncertainty. RESULTS In an optimistic scenario, assuming a 40% 5-year progression-free survival (PFS), axi-cel increased life expectancy by 8.2 years at $129,000/QALY gained (95% uncertainty interval, $90,000 to $219,000). At a 30% 5-year PFS, improvements in life expectancy were more modest (6.4 years) and expensive ($159,000/QALY gained [95% uncertainty interval, $105,000 to $284,000]). In an optimistic scenario, assuming a 35% 5-year PFS, tisagenlecleucel increased life expectancy by 4.6 years at $168,000/QALY gained (95% uncertainty interval, $105,000 to $414,000/QALY). At a 25% 5-year PFS, improvements in life expectancy were smaller (3.4 years) and more expensive ($223,000/QALY gained [95% uncertainty interval, $123,000 to $1,170,000/QALY]). Administering CAR-T to all indicated patients would increase US health care costs by approximately $10 billion over 5 years. Price reductions to $250,000 and $200,000, respectively, or payment only for initial complete response (at current prices) would allow axi-cel and tisagenlecleucel to cost less than $150,000/QALY, even at 25% PFS. CONCLUSION At 2018 prices, it is possible that both CAR-T therapies meet a less than $150,000/QALY threshold. This depends on long-term outcomes compared with chemoimmunotherapy and stem-cell transplantation, which are uncertain. Widespread adoption would substantially increase non-Hodgkin lymphoma health care costs. Price reductions or payment for initial response would improve cost effectiveness, even with modest long-term outcomes.
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Affiliation(s)
- John K Lin
- 1Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.,2Stanford University, Stanford, CA
| | - Lori S Muffly
- 3Stanford University School of Medicine, Stanford, CA
| | | | - James I Barnes
- 1Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.,2Stanford University, Stanford, CA
| | - Douglas K Owens
- 1Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.,2Stanford University, Stanford, CA
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Yu J, Parasuraman S, Shah A, Weisdorf D. Mortality, length of stay and costs associated with acute graft-versus-host disease during hospitalization for allogeneic hematopoietic stem cell transplantation. Curr Med Res Opin 2019; 35:983-988. [PMID: 30461314 DOI: 10.1080/03007995.2018.1551193] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Acute graft-versus-host disease (aGVHD) is a common and life-threatening complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). The extent to which aGVHD increases inpatient costs associated with allo-HSCT has not been thoroughly evaluated. In this analysis, mortality, hospital length of stay (LOS) and costs associated with aGVHD during allo-HSCT admissions are evaluated. METHODS This is a retrospective analysis of discharge records from the National Inpatient Sample database for patients receiving allo-HSCT between 1 January 2009 and 31 December 2013. Allo-HSCT discharges with an aGVHD diagnosis were included in the aGVHD group and those without any graft-versus-host disease (GVHD) diagnosis comprised the non-GVHD group. Mortality, LOS and costs were compared between the two groups, as well as within subgroups, including age (<18 vs. ≥18 years) and survival status (alive vs. deceased) at discharge. RESULTS Overall, mortality (16.2% vs. 5.3%; p < .01), median hospital LOS (42.0 vs. 26.0 days; p < .01) and median total costs ($173,144 vs. $98,982; p < .01) were significantly increased in patients with aGVHD versus those without GVHD during hospitalizations for allo-HSCT, irrespective of age group. Patients with aGVHD who were <18 years of age had a lower mortality rate but greater hospital LOS and total costs versus patients aged ≥18 years. Patients who died during allo-HSCT hospitalization had longer LOS and incurred greater costs than those who survived in both the aGVHD and non-GVHD groups. CONCLUSION Occurrence of aGVHD during allo-HSCT admissions resulted in a tripling of the mortality rate and a near doubling of hospital LOS and total costs. In addition, death during allo-HSCT hospitalizations was associated with greater healthcare utilization and costs. Effectively mitigating aGVHD may improve survival and substantially reduce hospital LOS and costs for allo-HSCT.
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Affiliation(s)
- Jingbo Yu
- a Incyte Corporation, US Medical Affairs , Wilmington , DE , USA
| | | | - Anshul Shah
- b Evidera Inc. , Modeling and Simulation , Waltham , MA , USA
| | - Daniel Weisdorf
- c University of Minnesota , Department of Medicine, Division of Hematology, Oncology and Transplantation , Minneapolis , MN , USA
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Feasibility and cost analysis of day 4 granulocyte colony-stimulating factor mobilized peripheral blood progenitor cell collection from HLA-matched sibling donors. Cytotherapy 2019; 21:725-737. [PMID: 31085121 DOI: 10.1016/j.jcyt.2019.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 02/08/2019] [Accepted: 04/01/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Guidelines recommend treatment with 4-5 days of granulocyte colony-stimulating factor (G-CSF) for optimal donor peripheral blood progenitor cell (PBPC) mobilization followed by day 5 collection. Given that some autologous transplant recipients achieve adequate collection by day 4 and the possibility that some allogeneic donors may maximally mobilize PBPC before day 5, a feasibility study was performed evaluating day 4 allogeneic PBPC collection. METHODS HLA-matched sibling donors underwent collection on day 4 of G-CSF for peripheral blood (PB) CD34+ counts ≥0.04 × 106/mL, otherwise they underwent collection on day 5. Those with inadequate collected CD34+ cells/kg recipient weight underwent repeat collection over 2 days. Transplant and PBPC characteristics and cost analysis were compared with a historical cohort collected on day 5 per our prior institutional algorithm. RESULTS Of the 101 patient/donor pairs, 50 (49.5%) had adequate PBPC collection on day 4, with a median PB CD34+ cell count of 0.06 × 106/mL. Day 4 donors were more likely to develop bone pain and require analgesics. Median collected CD34+ count was significantly greater, whereas total nucleated, mononuclear and CD3+ cell counts were significantly lower, at time of transplant infusion for day 4 versus other collection cohorts. There were no significant differences in engraftment or graft-versus-host disease. Cost analysis revealed 6.7% direct cost savings for day 4 versus historical day 5 collection. DISCUSSION Day 4 PB CD34+ threshold of ≥0.04 × 106/mL identified donors with high likelihood of adequate PBPC collection. Day 4 may be the optimal day of collection for healthy donors, without adverse effect on recipient transplant outcomes and with expected cost savings.
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Rangarajan HG, Smith LC, Stanek JR, Hall M, Abu-Arja R, Auletta JJ, O'Brien SH. Increased Health Care Utilization and Costs during Allogeneic Hematopoietic Cell Transplantation for Acute Leukemia and Myelodysplastic Syndromes in Adolescents and Young Adults Compared with Children: A Multicenter Study. Biol Blood Marrow Transplant 2019; 25:1031-1038. [DOI: 10.1016/j.bbmt.2019.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/01/2019] [Indexed: 12/11/2022]
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Cho SK, McCombs J, Punwani N, Lam J. Complications and hospital costs during hematopoietic stem cell transplantation for non-Hodgkin lymphoma in the United States. Leuk Lymphoma 2019; 60:2464-2470. [DOI: 10.1080/10428194.2019.1581932] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Sang Kyu Cho
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
| | - Jeffrey McCombs
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
| | - Nathan Punwani
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jenny Lam
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
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Mehta RS, Rezvani K, Shpall EJ. Cord Blood Expansion: A Clinical Advance. J Clin Oncol 2019; 37:363-366. [DOI: 10.1200/jco.18.01789] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Zhou ZY, Tang W, Villa KF. Indirect costs associated with premature mortality among those with veno-occlusive disease/sinusoidal obstruction syndrome with multiorgan dysfunction post-hematopoietic stem-cell-transplant. CLINICOECONOMICS AND OUTCOMES RESEARCH 2018; 11:13-22. [PMID: 30588050 PMCID: PMC6301294 DOI: 10.2147/ceor.s184883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The study objective was to develop an economic model to assess projected costs of lost productivity associated with premature deaths due to veno-occlusive disease (VOD)/ sinusoidal obstruction syndrome (SOS) with multiorgan dysfunction (MOD) among patients in the US who underwent hematopoietic stem-cell transplant (HSCT) in 2013. Methods Data sources included the US Census Bureau and Department of Health, epidemiologic research organizations, and medical research literature. The model considered only lost productivity associated with premature death, with lifetime salary assumed to reflect productivity. Average annual salary was assumed to be the same for HSCT survivors and the general population, with a working age range between 18 and 65 years. Key data inputs included number of HSCTs by graft type (allogeneic and autologous) performed in the US in 2013, HSCT-related mortality, mortality associated with VOD/SOS with MOD, and life-expectancy reduction for HSCT survivors vs the general population. Excess mortality equaled total deaths among patients with VOD/SOS and MOD minus deaths in these patients due to causes other than VOD/SOS with MOD. Results Among 18,284 patients who underwent HSCT in the US in 2013, the model estimated that 361 excess deaths due to VOD/SOS with MOD occurred (158 following allogeneic and 203 after autologous transplants). These deaths accounted for total lost work productivity of 5,990 years and $124,212,173 in lost wages, averaging 17 years and $343,791 per patient. A sensitivity analysis incorporating adjustment factors for epidemiologic and economic inputs calculated total financial loss of $84 million to $194 million. Limitation Estimates of post-HSCT VOD/SOS with MOD incidence and mortality were approximated, due to changing HSCT practices. Conclusion Premature death due to VOD/SOS with MOD imposes a substantial economic burden in this population in terms of lost productivity. Additional studies of this economic burden are warranted.
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Affiliation(s)
| | | | - Kathleen F Villa
- Health Economics and Outcomes Research, Jazz Pharmaceuticals, Palo Alto, CA, USA,
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Shah GL, Majhail N, Khera N, Giralt S. Value-Based Care in Hematopoietic Cell Transplantation and Cellular Therapy: Challenges and Opportunities. Curr Hematol Malig Rep 2018; 13:125-134. [PMID: 29484578 DOI: 10.1007/s11899-018-0444-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Improved tolerability and outcomes after hematopoietic cell transplantation (HCT), along with the availability of alternative donors, have expanded its use. With this growth, and the development of additional cellular therapies, we also aim to increase effectiveness, efficiency, and the quality of the care provided. Fundamentally, the goal of value-based care is to have better health outcomes with streamlined processes, improved patient experience, and lower costs for both the patients and the health care system. HCT and cellular therapy treatments are multiphase treatments which allow for interventions at each juncture. RECENT FINDINGS We present a summary of the current literature with focus on program structure and overall system capacity, coordination of therapy across providers, standardization across institutions, diversity and disparities in care, patient quality of life, and cost implications. Each of these topics provides challenges and opportunities to improve value-based care for HCT and cellular therapy patients.
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Affiliation(s)
- Gunjan L Shah
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 298, New York, NY, 10065, USA.
| | - Navneet Majhail
- Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA
| | - Nandita Khera
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Sergio Giralt
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 298, New York, NY, 10065, USA
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Mayerhoff L, Lehne M, Hickstein L, Salimullah T, Prieur S, Thomas SK, Zhang J. Cost associated with hematopoietic stem cell transplantation: a retrospective claims data analysis in Germany. J Comp Eff Res 2018; 8:121-131. [PMID: 30517020 DOI: 10.2217/cer-2018-0100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
AIM Quantify hematopoietic stem cell transplantation (HSCT) costs in German patients with acute lymphoblastic leukemia (ALL), diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL). METHODS The primary outcome was direct and indirect costs in patients with ALL/DLBCL/FL who received HSCT between 2010 and 2014. Costs were evaluated two to four quarters before to eight quarters after HSCT. RESULTS Among 258 patients with HSCT, direct costs were €290,125/patient (pediatric ALL), €246,266/patient (adult ALL), €230,399/patient (DLBCL/FL allogeneic) and €107,457/patient (DLBCL/FL autologous). Indirect costs with HSCT were €52,939/patient (adult ALL), €20,285/patient (DLBCL/FL allogeneic) and €29,881/patient (DLBCL/FL autologous). CONCLUSION Direct and indirect costs associated with HSCT are substantial for patients with ALL, DLBCL and FL. Novel therapies that reduce HSCT use could reduce medical costs.
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Affiliation(s)
| | | | | | | | | | - Simu K Thomas
- Novartis Pharmaceuticals Corporation, East Hanover, NJ 07936, USA
| | - Jie Zhang
- Novartis Pharmaceuticals Corporation, East Hanover, NJ 07936, USA
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Vairy S, Garcia JL, Teira P, Bittencourt H. CTL019 (tisagenlecleucel): CAR-T therapy for relapsed and refractory B-cell acute lymphoblastic leukemia. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:3885-3898. [PMID: 30518999 PMCID: PMC6237143 DOI: 10.2147/dddt.s138765] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Over the past decades, survival of patients with acute lymphoblastic leukemia (ALL) has dramatically improved, but the subgroup of patients with relapsed/refractory ALL still continues to have dismal prognosis. As an emerging therapeutic approach, chimeric antigen receptor-modified T-cells (CAR-T) represent one of the few practice-changing therapies for this subgroup of patients. Originally conceived and built in Philadelphia (University of Pennsylvania), CTL019 or tisagenlecleucel, the first CAR-T approved by the US Food and Drug Administration, showed impressive results in refractory/relapsed ALL since the publication on two pediatric patients in 2013. It is in this context that we provide a review of this product in terms of manufacturing, pharmacology, toxicity, and efficacy studies. Evaluation and management of toxicities, particularly cytokine release syndrome and neurotoxicity, is recognized as an essential part of the patient treatment with broader use of IL-6 receptor inhibitor. An under-assessed aspect, the quality of life of patients entering CAR-T cells treatment, will also be reviewed. By their unique nature, CAR-T cells such as tisagenlecleucel operate in a different way than typical drugs, but also provide unique hope for B-cell malignancies.
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Affiliation(s)
- Stephanie Vairy
- Division of Haematology and Oncology, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada,
| | - Julia Lopes Garcia
- Division of Haematology and Oncology, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada,
| | - Pierre Teira
- Division of Haematology and Oncology, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada,
| | - Henrique Bittencourt
- Division of Haematology and Oncology, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada,
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van Sambeek B, Flattery M, Mitchell R, De Abreu Lourenco R. Comparing the cost of preparing matched unrelated donor and TCR α + β + /CD19 + depleted donor material for pediatric hematopoietic stem cell transplants in Australia. Pediatr Transplant 2018; 22:e13279. [PMID: 30091256 DOI: 10.1111/petr.13279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/12/2018] [Accepted: 07/18/2018] [Indexed: 01/11/2023]
Abstract
Use of TCR α+ β+ /CD19+ depletion in a pediatric setting has improved the utility of haploidentical donor material, resulting in better rates of engraftment, lower rates of graft vs host disease (GVHD), and improved transplant-related mortality. There are currently no data available on the costs of TCR α+ β+ /CD19+ depletion. This study assessed the costs of acquiring and preparing TCR α+ β+ /CD19+ depleted haploidentical donor cells in comparison with matched unrelated donor (MUD) products for use in pediatric patients in Australia. Data from four pediatric transplant centers were used to estimate the resources required for donor work-up, graft acquisition, and laboratory procedures for graft preparation. Information on MUD work-up and graft acquisition was also acquired from these sites and from the national coordinating donor center in Australia. Australian-specific prices and fees were used to estimate total average costs for each transplant type, converted to USD. Preparation of graft material (including work-up, acquisition, and laboratory processes) costs USD 28 963 for TCR α+ β+ /CD19+ depleted haploidentical grafts and USD 27 297 for MUD grafts. The estimated difference of USD 1666 is largely attributed to the process and consumables to perform TCR α+ β+ /CD19+ depletion. Given the potential for recipients of TCR α+ β+ /CD19+ depleted grafts to require minimal GVHD prophylaxis and experience less transplant-related morbidity and mortality, use of TCR α+ β+ /CD19+ depletion appears favorable despite the higher initial cost. Research is currently ongoing to assess the clinical effectiveness and potential cost-effectiveness of TCR α+ β+ /CD19+ depletion over a patients' lifetime.
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Affiliation(s)
- Björn van Sambeek
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Martin Flattery
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Richard Mitchell
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women and Children's Health, University of New South Wales, Randwick, NSW, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
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Wo SR, Largent EA, Brosco J, Rosenberg AR, Goodman KW, Lantos JD. Should Foreigners Get Costly Lifesaving Treatments in the United States? Pediatrics 2018; 142:peds.2018-0175. [PMID: 30279236 DOI: 10.1542/peds.2018-0175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2018] [Indexed: 11/24/2022] Open
Abstract
Many foreign parents bring their children to the United States for medical treatments that are unavailable in their own country. Often, however, parents cannot afford expensive treatments. Doctors and hospitals then face a dilemma. Is it ethically permissible to consider the patient's citizenship and ability to pay? In this Ethics Rounds, we present a case in which a child from another country needs an expensive treatment. His parents cannot afford the treatment. He has come to a public hospital in the United States. We present responses from experts in pediatrics, bioethics, and health policy.
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Affiliation(s)
- Shane R Wo
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington
| | - Emily A Largent
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey Brosco
- Department of Pediatrics, University of Miami, Coral Gables, Florida
| | - Abby R Rosenberg
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington.,Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, Washington
| | - Kenneth W Goodman
- Institute for Bioethics and Health Policy, Miller School of Medicine, University of Miami, Miami, Florida; and
| | - John D Lantos
- Children's Mercy Bioethics Center, Children's Mercy Hospital, Kansas City, Missouri
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Tang R, Su C, Bai HX, Zeng Z, Karakousis G, Zhang PJ, Zhang G, Xiao R. Association of insurance status with survival in patients with cutaneous T-cell lymphoma. Leuk Lymphoma 2018; 60:1253-1260. [PMID: 30326769 DOI: 10.1080/10428194.2018.1520987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The effect of insurance status on overall survival (OS) of patients with cutaneous T-cell lymphoma (CTCL) is unclear. We identified 11,861 patients from the US National Cancer Data Base diagnosed with CTCL from 2004-2014, of which 6088 had private insurance, 756 had Medicaid, 4536 had Medicare, and 481 are uninsured. Privately insured patients were more likely to present at an early stage (p < .001). On multivariate Cox regression analysis, privately insured patients had significantly longer OS than patients with Medicaid (HR: 1.936, 95% CI: 1.680-2.230, p < .001), Medicare (HR: 1.342, 95% CI: 1.222-1.474, p < .001), or no insurance (HR 1.849, 95% CI: 1.539-2.222, p < .001). The survival advantage of privately insured patients persisted on relative survival and propensity score-matched analyses. In conclusion, privately insured patients were more likely to present at an early stage, and had longer OS than patients who were Medicaid-, Medicare-, or not insured.
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Affiliation(s)
- Rui Tang
- a Department of Dermatology , The Second Xiangya Hospital, Central South University , Changsha , China
| | - Chang Su
- a Department of Dermatology , The Second Xiangya Hospital, Central South University , Changsha , China.,b Department of Dermatology , Yale School of Medicine , New Haven , CT , USA
| | - Harrison X Bai
- c Department of Radiology , Hospital of the University of Pennsylvania , Philadelphia , PA , USA
| | - Zhuotong Zeng
- a Department of Dermatology , The Second Xiangya Hospital, Central South University , Changsha , China
| | - Giorgos Karakousis
- d Department of Surgery , Hospital of the University of Pennsylvania , Philadelphia , PA , USA
| | - Paul J Zhang
- e Department of Pathology and Laboratory Medicine , Hospital of the University of Pennsylvania , Philadelphia , PA , USA
| | - Guiying Zhang
- a Department of Dermatology , The Second Xiangya Hospital, Central South University , Changsha , China
| | - Rong Xiao
- a Department of Dermatology , The Second Xiangya Hospital, Central South University , Changsha , China
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Huntington SF, von Keudell G, Davidoff AJ, Gross CP, Prasad SA. Cost-Effectiveness Analysis of Brentuximab Vedotin With Chemotherapy in Newly Diagnosed Stage III and IV Hodgkin Lymphoma. J Clin Oncol 2018; 36:JCO1800122. [PMID: 30285558 PMCID: PMC6241679 DOI: 10.1200/jco.18.00122] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE In a recent randomized, open-label trial (ECHELON-1), brentuximab vedotin (BV) combined with doxorubicin, vinblastine, and dacarbazine (AVD+BV) decreased the risk of progression in adults diagnosed with stage III or IV Hodgkin lymphoma (HL) compared with standard bleomycin-containing chemotherapy (doxorubicin, bleomycin, vinblastine, and dacarbazine [ABVD]). However, the cost effectiveness of incorporating BV (US$6,970 per 50-mg vial) into the first-line setting is unknown. PATIENTS AND METHODS We constructed a Markov decision-analytic model to measure the costs and clinical outcomes for AVD+BV compared with ABVD as first-line therapy in a cohort of patients with stage III or IV HL. Transition probabilities were estimated from ECHELON-1 by fitting parametric survival distributions. Lifetime direct health care costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for AVD+BV compared with ABVD from a US payer perspective. Our model was also used to estimate BV price reductions that would achieve more favorable cost effectiveness under indication-specific pricing. RESULTS AVD+BV was associated with an improvement of 0.56 QALYs compared with treatment with standard ABVD. However, incorporating BV into first-line therapy led to significantly higher lifetime health care costs ($361,137 v $184,291), causing the ICER for AVD+BV to be $317,254 per QALY. If indication-specific pricing were implemented, acquisition costs for BV used in the first-line setting would need to be reduced by 56% to 73% for ICERs of $150,000 to $100,000 per QALY, respectively. CONCLUSION Substituting BV for bleomycin during first-line therapy for stage III or IV HL is unlikely to be cost effective under current drug pricing. Should indication-specific pricing be implemented, significant price reductions for BV used in the first-line setting would be needed to reduce ICERs to more widely acceptable values.
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Affiliation(s)
- Scott F. Huntington
- Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale School of Medicine; Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amy J. Davidoff, Yale School of Public Health; Sapna A. Prasad, Smilow Cancer Hospital at Yale-New Haven Health, New Haven, CT; and Gottfried von Keudell, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Gottfried von Keudell
- Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale School of Medicine; Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amy J. Davidoff, Yale School of Public Health; Sapna A. Prasad, Smilow Cancer Hospital at Yale-New Haven Health, New Haven, CT; and Gottfried von Keudell, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Amy J. Davidoff
- Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale School of Medicine; Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amy J. Davidoff, Yale School of Public Health; Sapna A. Prasad, Smilow Cancer Hospital at Yale-New Haven Health, New Haven, CT; and Gottfried von Keudell, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Cary P. Gross
- Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale School of Medicine; Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amy J. Davidoff, Yale School of Public Health; Sapna A. Prasad, Smilow Cancer Hospital at Yale-New Haven Health, New Haven, CT; and Gottfried von Keudell, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Sapna A. Prasad
- Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale School of Medicine; Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amy J. Davidoff, Yale School of Public Health; Sapna A. Prasad, Smilow Cancer Hospital at Yale-New Haven Health, New Haven, CT; and Gottfried von Keudell, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY
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Yeh AC, Khan MA, Harlow J, Biswas AR, Akter M, Ferdous J, Ara T, Islam M, Caron M, Barron AM, Moran J, Brezina M, Nazneen H, Kamruzzaman M, Saha A, Marshall A, Afrose S, Stowell C, Preffer F, Bangsberg D, Goodman A, Attar E, McAfee S, Spitzer TR, Dey BR. Hematopoietic Stem-Cell Transplantation in the Resource-Limited Setting: Establishing the First Bone Marrow Transplantation Unit in Bangladesh. J Glob Oncol 2018; 4:1-10. [PMID: 30241180 PMCID: PMC6223381 DOI: 10.1200/jgo.2016.006460] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Treatment of malignant and nonmalignant hematologic diseases with hematopoietic stem-cell transplantation (HSCT) was first described almost 60 years ago, and its use has expanded significantly over the last 20 years. Whereas HSCT has become the standard of care for many patients in developed countries, the significant economic investment, infrastructure, and health care provider training that are required to provide such a service have prohibited it from being widely adopted, particularly in developing countries. METHODS Over the past two decades, however, efforts to bring HSCT to the developing world have increased, and several institutions have described their efforts to establish such a program. We aim to provide an overview of the current challenges and applications of HSCT in developing countries as well as to describe our experience in developing an HSCT program at Dhaka Medical College and Hospital in Bangladesh via a partnership with health care providers at Massachusetts General Hospital. RESULTS AND CONCLUSION We discuss key steps of the program, including the formation of a collaborative partnership, infrastructure development, human resource capacity building, and financial considerations.
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Affiliation(s)
- Albert C Yeh
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Mohiuddin A Khan
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Jason Harlow
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Akhil R Biswas
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Mafruha Akter
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Jannatul Ferdous
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Tasneem Ara
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Manirul Islam
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Martin Caron
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Anne-Marie Barron
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Jenna Moran
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Mark Brezina
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Humayra Nazneen
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Md Kamruzzaman
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Anup Saha
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Ariela Marshall
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Salma Afrose
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Christopher Stowell
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Frederic Preffer
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - David Bangsberg
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Annekathryn Goodman
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Eyal Attar
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Steven McAfee
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Thomas R Spitzer
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Bimalangshu R Dey
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
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Pandrangi V, Reiter ER. The Burden of Sinusitis in Hematologic Transplant Patients: A National Perspective. Laryngoscope 2018; 128:2688-2692. [PMID: 30239988 DOI: 10.1002/lary.27363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine the impact of sinusitis on outcomes of hematologic transplant procedures. STUDY DESIGN Retrospective analysis of a national hospital database. METHODS The National Inpatient Sample database for 2012 to 2013 was queried using International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify patients undergoing hematologic transplants. Patients were divided based upon the presence or absence of a concomitant diagnosis of acute or chronic sinusitis. Patient demographics, clinical characteristics, discharge results, lengths of stay (LOS), and costs were compared between groups. RESULTS There were 7,069 hematologic transplant cases identified, 2.7% of which had a diagnosis of sinusitis. Sinusitis patients had a longer LOS after transplant (24.9 ± 15.9 days vs. 19.1 ± 17.4 days, P < .001) and higher total hospital charges ($487,941 ± $447,532 vs. $322,300 ± $369,596, P < .001) than nonsinusitis patients. There was no difference in mortality between the two groups (P = .75). The 23 (12%) sinusitis patients who underwent sinus procedures had a longer LOS after transplant (34.8 ± 25 days vs. 23.5 ± 13.7 days, P = .001) and higher total hospital charges ($857,891 ± $718,456 vs. $437,293 ± $372,075, P < .001) than sinusitis patients without sinus procedures. Linear regression showed that sinusitis patients had excess LOS after transplant of 2.442 days and cost of $82,000.098. CONCLUSIONS This study demonstrates that presence of sinusitis in patients undergoing hematologic transplant is associated with increased LOS and higher total hospital charges. Increased focus on diagnosis and if possible treatment of sinusitis prior to admission for transplantation may help reduce the impact of sinusitis after hematologic transplant. LEVEL OF EVIDENCE NA Laryngoscope, 128:2688-2692, 2018.
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Affiliation(s)
- Vivek Pandrangi
- From the Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A
| | - Evan R Reiter
- From the Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A
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71
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Lin JK, Lerman BJ, Barnes JI, Boursiquot BC, Tan YJ, Robinson AQL, Davis KL, Owens DK, Goldhaber-Fiebert JD. Cost Effectiveness of Chimeric Antigen Receptor T-Cell Therapy in Relapsed or Refractory Pediatric B-Cell Acute Lymphoblastic Leukemia. J Clin Oncol 2018; 36:3192-3202. [PMID: 30212291 DOI: 10.1200/jco.2018.79.0642] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The anti-CD19 chimeric antigen receptor T-cell therapy tisagenlecleucel was recently approved to treat relapsed or refractory pediatric acute lymphoblastic leukemia. With a one-time infusion cost of $475,000, tisagenlecleucel is currently the most expensive oncologic therapy. We aimed to determine whether tisagenlecleucel is cost effective compared with currently available treatments. METHODS Markov modeling was used to evaluate tisagenlecleucel in pediatric relapsed or refractory acute lymphoblastic leukemia from a US health payer perspective over a lifetime horizon. The model was informed by recent multicenter, single-arm clinical trials. Tisagenlecleucel (under a range of plausible long-term effectiveness) was compared with blinatumomab, clofarabine combination therapy (clofarabine, etoposide, and cyclophosphamide), and clofarabine monotherapy. Scenario and probabilistic sensitivity analyses were used to explore uncertainty. Main outcomes were life-years, discounted lifetime costs, discounted quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (3% discount rate). RESULTS With an assumption of a 40% 5-year relapse-free survival rate, tisagenlecleucel increased life expectancies by 12.1 years and cost $61,000/QALY gained. However, at a 20% 5-year relapse-free survival rate, life-expectancies were more modest (3.8 years) and expensive ($151,000/QALY gained). At a 0% 5-year relapse-free survival rate and with use as a bridge to transplant, tisagenlecleucel increased life expectancies by 5.7 years and cost $184,000/QALY gained. Reduction of the price of tisagenlecleucel to $200,000 or $350,000 would allow it to meet a $100,000/QALY or $150,000/QALY willingness-to-pay threshold in all scenarios. CONCLUSION The long-term effectiveness of tisagenlecleucel is a critical but uncertain determinant of its cost effectiveness. At its current price, tisagenlecleucel represents reasonable value if it can keep a substantial fraction of patients in remission without transplantation; however, if all patients ultimately require a transplantation to remain in remission, it will not be cost effective at generally accepted thresholds. Price reductions would favorably influence cost effectiveness even if long-term clinical outcomes are modest.
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Affiliation(s)
- John K Lin
- John K. Lin, James I. Barnes, and Douglas K. Owens, Veterans Affairs Palo Alto Health Care System, Palo Alto; John K. Lin, James I. Barnes, Alex Q.L. Robinson, Douglas K. Owens, and Jeremy D. Goldhaber-Fiebert, Stanford University; and Benjamin J. Lerman, Brian C. Boursiquot, Yuan Jin Tan, and Kara L. Davis, Stanford University School of Medicine, Stanford, CA
| | - Benjamin J Lerman
- John K. Lin, James I. Barnes, and Douglas K. Owens, Veterans Affairs Palo Alto Health Care System, Palo Alto; John K. Lin, James I. Barnes, Alex Q.L. Robinson, Douglas K. Owens, and Jeremy D. Goldhaber-Fiebert, Stanford University; and Benjamin J. Lerman, Brian C. Boursiquot, Yuan Jin Tan, and Kara L. Davis, Stanford University School of Medicine, Stanford, CA
| | - James I Barnes
- John K. Lin, James I. Barnes, and Douglas K. Owens, Veterans Affairs Palo Alto Health Care System, Palo Alto; John K. Lin, James I. Barnes, Alex Q.L. Robinson, Douglas K. Owens, and Jeremy D. Goldhaber-Fiebert, Stanford University; and Benjamin J. Lerman, Brian C. Boursiquot, Yuan Jin Tan, and Kara L. Davis, Stanford University School of Medicine, Stanford, CA
| | - Brian C Boursiquot
- John K. Lin, James I. Barnes, and Douglas K. Owens, Veterans Affairs Palo Alto Health Care System, Palo Alto; John K. Lin, James I. Barnes, Alex Q.L. Robinson, Douglas K. Owens, and Jeremy D. Goldhaber-Fiebert, Stanford University; and Benjamin J. Lerman, Brian C. Boursiquot, Yuan Jin Tan, and Kara L. Davis, Stanford University School of Medicine, Stanford, CA
| | - Yuan Jin Tan
- John K. Lin, James I. Barnes, and Douglas K. Owens, Veterans Affairs Palo Alto Health Care System, Palo Alto; John K. Lin, James I. Barnes, Alex Q.L. Robinson, Douglas K. Owens, and Jeremy D. Goldhaber-Fiebert, Stanford University; and Benjamin J. Lerman, Brian C. Boursiquot, Yuan Jin Tan, and Kara L. Davis, Stanford University School of Medicine, Stanford, CA
| | - Alex Q L Robinson
- John K. Lin, James I. Barnes, and Douglas K. Owens, Veterans Affairs Palo Alto Health Care System, Palo Alto; John K. Lin, James I. Barnes, Alex Q.L. Robinson, Douglas K. Owens, and Jeremy D. Goldhaber-Fiebert, Stanford University; and Benjamin J. Lerman, Brian C. Boursiquot, Yuan Jin Tan, and Kara L. Davis, Stanford University School of Medicine, Stanford, CA
| | - Kara L Davis
- John K. Lin, James I. Barnes, and Douglas K. Owens, Veterans Affairs Palo Alto Health Care System, Palo Alto; John K. Lin, James I. Barnes, Alex Q.L. Robinson, Douglas K. Owens, and Jeremy D. Goldhaber-Fiebert, Stanford University; and Benjamin J. Lerman, Brian C. Boursiquot, Yuan Jin Tan, and Kara L. Davis, Stanford University School of Medicine, Stanford, CA
| | - Douglas K Owens
- John K. Lin, James I. Barnes, and Douglas K. Owens, Veterans Affairs Palo Alto Health Care System, Palo Alto; John K. Lin, James I. Barnes, Alex Q.L. Robinson, Douglas K. Owens, and Jeremy D. Goldhaber-Fiebert, Stanford University; and Benjamin J. Lerman, Brian C. Boursiquot, Yuan Jin Tan, and Kara L. Davis, Stanford University School of Medicine, Stanford, CA
| | - Jeremy D Goldhaber-Fiebert
- John K. Lin, James I. Barnes, and Douglas K. Owens, Veterans Affairs Palo Alto Health Care System, Palo Alto; John K. Lin, James I. Barnes, Alex Q.L. Robinson, Douglas K. Owens, and Jeremy D. Goldhaber-Fiebert, Stanford University; and Benjamin J. Lerman, Brian C. Boursiquot, Yuan Jin Tan, and Kara L. Davis, Stanford University School of Medicine, Stanford, CA
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Radojcic V, Lee CJ, Couriel DR. Multifaceted Burden of Chronic Graft-versus-Host Disease. Biol Blood Marrow Transplant 2018; 24:1774-1775. [DOI: 10.1016/j.bbmt.2018.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 07/09/2018] [Indexed: 12/15/2022]
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73
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Bourgeois W, Ricci A, Jin Z, Hall M, George D, Bhatia M, Garvin J, Satwani P. Health care utilization and cost among pediatric patients receiving unrelated donor allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2018; 54:691-699. [DOI: 10.1038/s41409-018-0308-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/26/2018] [Accepted: 07/24/2018] [Indexed: 11/09/2022]
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74
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Das K, Khanna T, Agrawal N. Establishing Hematopoietic Stem Cell Transplant Unit in Resource Limited Setting: A Critical Analysis of Indian Council of Medical Research 2017 Guidelines. J Transplant 2018; 2018:1292307. [PMID: 30174945 PMCID: PMC6106904 DOI: 10.1155/2018/1292307] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 07/29/2018] [Indexed: 02/04/2023] Open
Abstract
The scope and application of hematopoietic stem cell transplantation are increasing. With advancement in science and close cooperation of health centers, HSCT units are coming up in new developing and underdeveloped countries. India hosts many HSCT units and often provides financially viable option for HSCT to foreign patients as well. Recently Indian Council of Medical Research (ICMR) issued a guideline about HSCT unit in India. This review article discusses establishment of new HSCT unit in resource limited setting. Subsequent implication of ICMR guideline has been done.
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Affiliation(s)
- Kunal Das
- Cancer Research Institute, Swami Rama Himalayan University, Dehradun, India
| | - Tanvi Khanna
- Cancer Research Institute, Swami Rama Himalayan University, Dehradun, India
| | - Nitika Agrawal
- Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India
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75
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Chen Q, Staton AD, Ayer T, Goldstein DA, Koff JL, Flowers CR. Exploring the potential cost-effectiveness of precision medicine treatment strategies for diffuse large B-cell lymphoma. Leuk Lymphoma 2018; 59:1700-1709. [PMID: 29065744 PMCID: PMC5918224 DOI: 10.1080/10428194.2017.1390230] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Activated B-cell-like (ABC) diffuse large B-cell lymphoma (DLBCL) is associated with worse survival after standard rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (RCHOP) chemoimmunotherapy compared to germinal center B-cell-like (GCB) subtype. Preliminary evidence suggests that benefits from novel agents may vary by subtype. Hypothesizing that treatment stratified by DLBCL subtype could be potentially cost-effective, we developed micro-simulation models to compare three first-line treatment strategies: (1) standard RCHOP for all patients (2) subtype testing followed by RCHOP for GCB and novel treatment for ABC DLBCL, and (3) novel treatment for all patients. Based on phase 2 evidence, we used lenalidomide + RCHOP as a surrogate novel treatment. The subtype-based approach showed a favorable incremental cost-effectiveness ratio of $15,015/quality-adjusted life year compared with RCHOP. Although our exploratory analyses demonstrated a wide range of conditions where subtype-based treatment remained cost-effective, data from phase 3 trials are needed to validate our models' findings and draw definitive conclusions.
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MESH Headings
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Combined Chemotherapy Protocols
- Cost-Benefit Analysis
- Cyclophosphamide
- Disease Management
- Doxorubicin
- Female
- Health Care Costs
- Humans
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/epidemiology
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/therapy
- Male
- Models, Theoretical
- Precision Medicine/economics
- Precision Medicine/methods
- Precision Medicine/standards
- Prednisone
- Prognosis
- Rituximab
- SEER Program
- Treatment Outcome
- Vincristine
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Affiliation(s)
- Qiushi Chen
- Massachusetts General Hospital Institute for Technology Assessment, Boston, MA
- Harvard Medical School, Boston, MA
| | - Ashley D. Staton
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Turgay Ayer
- H. Milton Stewart School of Industrial & Systems Engineering, Georgia Institute of Technology, Atlanta, GA
| | - Daniel A. Goldstein
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
- Davidoff Center, Rabin Medical Center, Petach Tikvah, Israel
| | - Jean L. Koff
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Christopher R. Flowers
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
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Cooper JP, Scott BL. Allogeneic transplantation for myelofibrosis with adverse risk karyotype: Attack on the clones? Am J Hematol 2018; 93:603-604. [PMID: 29498109 DOI: 10.1002/ajh.25078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 02/27/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Jason P. Cooper
- Clinical Research Division; Fred Hutchinson Cancer Research Center; Seattle Washington
- Division of Hematology; University of Washington; Seattle Washington
| | - Bart L. Scott
- Clinical Research Division; Fred Hutchinson Cancer Research Center; Seattle Washington
- Division of Medical Oncology; University of Washington; Seattle Washington
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77
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McGrady ME, Joffe NE, Pai ALH. Earlier Pediatric Psychology Consultation Predicts Lower Stem Cell Transplantation Hospital Costs. J Pediatr Psychol 2018; 43:434-442. [PMID: 29048570 DOI: 10.1093/jpepsy/jsx124] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 09/24/2017] [Indexed: 02/07/2023] Open
Abstract
Objective The purpose of this study was to examine the hypothesis that earlier time to psychology consultation would predict lower costs for the initial stem cell transplant (SCT) hospitalization among patients receiving care at a children's hospital. Methods A retrospective medical record review identified 75 patients (ages 0-32 years) with one or more visits by a licensed clinical psychologist during the initial SCT hospitalization from 2010 to 2014. Demographic and clinical variables were obtained from the electronic medical record and hospitalization costs were obtained from patient billing records. A generalized linear model with a gamma distribution and log link function was used to estimate the relationship between time to psychology consultation and cost for the initial SCT hospitalization while controlling for demographic, clinical, and utilization factors. Results After controlling for age at SCT, gender, race, insurance status, diagnosis, SCT type, length of stay, and number of psychology visits, earlier time to psychology consultation predicted lower costs for the initial SCT hospitalization (χ2 = 6.83, p = .01). When the effects of covariates were held constant, every day increase in the time to psychology consultation was associated with a 0.3% increase in SCT hospitalization costs (β = 0.003, SE = 0.001). Conclusions Results suggest that facilitating consultations with a pediatric psychologist early in the initial SCT hospitalization may reduce costs for patients undergoing SCT at children's hospitals. Future research is needed to determine the optimal timing of psychology consultation and quantify the economic impact of psychological services.
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Affiliation(s)
- Meghan E McGrady
- Division of Behavioral Medicine and Clinical Psychology, Patient and Family Wellness Center
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Naomi E Joffe
- Division of Behavioral Medicine and Clinical Psychology, Patient and Family Wellness Center
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ahna L H Pai
- Division of Behavioral Medicine and Clinical Psychology, Patient and Family Wellness Center
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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78
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Yin X, Tang L, Fan F, Jiang Q, Sun C, Hu Y. Allogeneic stem-cell transplantation for multiple myeloma: a systematic review and meta-analysis from 2007 to 2017. Cancer Cell Int 2018; 18:62. [PMID: 29713245 PMCID: PMC5913895 DOI: 10.1186/s12935-018-0553-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 04/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background Despite recent advances, multiple myeloma (MM) remains incurable. However, the appearance of allogeneic stem cell transplantation (allo-SCT) through graft-versus-myeloma effect provides a potential way to cure MM to some degree. This systematic review aimed to evaluate the outcome of patients receiving allo-SCT and identified a series of prognostic factors that may affect the outcome of allo-SCT. Patients/methods We systematically searched PubMed, Embase, and the Cochrane Library from 2007.01.01 to 2017.05.03 using the keywords ‘allogeneic’ and ‘myeloma’. Results A total of 61 clinical trials involving 8698 adult patients were included. The pooled estimates (95% CI) for overall survival (OS) at 1, 2, 3 and 5 years were 70 (95% CI 56–84%), 62 (95% CI 53–71%), 52 (95% CI 44–61%), and 46 (95% CI 40–52%), respectively; for progression-free survival were 51 (95% CI 38–64%), 40 (95% CI 32–48%), 34 (95% CI 27–41%), and 27 (95% CI 23–31%), respectively; and for treatment-related mortality (TRM) were 18 (95% CI 14–21%), 21 (95% CI 17–25%), 20 (95% CI 13–26%), and 27 (95% CI 21–33%), respectively. Additionally, the pooled 100-day TRM was 12 (95% CI 5–18%). The incidences of grades II–IV acute graft-versus-host disease (GVHD) and chronic GVHD were 34 (95% CI 30–37%) and 51 (95% CI 46–56%), respectively. The incidences of relapse rate (RR) and death rate were 50 (95% CI 45–55%) and 51 (95% CI 45–57%), respectively. Importantly, disease progression was the most major cause of death (48%), followed by TRM (44%). The results failed to show an apparent benefit of allo-SCT for standard risk patients, compared with tandem auto-SCT. In contrast, all 14 trials in our study showed that patients with high cytogenetic risk after allo-SCT had similar OS and PFS compared to those with standard risk, suggesting that allo-SCT may overcome the adverse prognosis of high cytogenetic risk. Conclusion Due to the lack of consistent survival benefit, allo-SCT should not be considered as a standard of care for newly diagnosed and relapsed standard-risk MM patients. However, for patients with high-risk MM who have a poor long-term prognosis, allo-SCT may be a strong consideration in their initial course of therapy or in first relapse after chemotherapy, when the risk of disease progression may outweigh the transplant-related risks. A large number of prospective randomized controlled trials were needed to prove the benefits of these therapeutic options. Electronic supplementary material The online version of this article (10.1186/s12935-018-0553-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xuejiao Yin
- 1Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Dadao, Wuhan, 430022 China
| | - Liang Tang
- 1Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Dadao, Wuhan, 430022 China
| | - Fengjuan Fan
- 1Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Dadao, Wuhan, 430022 China
| | - Qinyue Jiang
- 2Collaborative Innovation Center of Hematology, Huazhong University of Science and Technology, Jiefang Dadao, Wuhan, 430022 China
| | - Chunyan Sun
- 1Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Dadao, Wuhan, 430022 China.,2Collaborative Innovation Center of Hematology, Huazhong University of Science and Technology, Jiefang Dadao, Wuhan, 430022 China
| | - Yu Hu
- 1Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Dadao, Wuhan, 430022 China.,2Collaborative Innovation Center of Hematology, Huazhong University of Science and Technology, Jiefang Dadao, Wuhan, 430022 China
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Cost-effectiveness analysis of haploidentical vs matched unrelated allogeneic hematopoietic stem cells transplantation in patients older than 55 years. Bone Marrow Transplant 2018. [PMID: 29523885 DOI: 10.1038/s41409-018-0133-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Due to limited donor availability, high comorbidities, and cost issues, allogeneic hematopoietic stem cell transplant is not universally accessible. The aim of this study was to conduct a cost-effectiveness analysis of haploidentical vs matched unrelated transplant. This retrospective study included patients with hematological malignancies older than 55 years who underwent haploidentical or matched unrelated transplant between 2011 and 2013 in Marseille. The incremental cost-effectiveness ratio has been calculated using the mean overall survival and the mean transplant costs. Costs were calculated using a micro-costing strategy from the hospital perspective and a time horizon at 2 years. Haploidentical transplant was considered an innovative procedure and matched unrelated transplant as the reference. Probabilistic and sensitivity analyses were performed on the incremental cost-effectiveness ratio. During inclusion, 29 patients underwent haploidentical transplant and 63 matched unrelated transplant. In haploidentical and matched unrelated transplant, the mean overall survival was 19.4 (1.6) months and 15.1 (1.2) months (p = 0.06), respectively, and the mean cost was 98,304 (40,872) € and 151,373 (65,742) € (p < 0.01), respectively. The incremental cost-effectiveness ratio was assessed to -148,485 (-1,265,550; -64,368) € per life year gained. Among older patients suffering from hematological malignancies, haploidentical transplant seemed in our analysis to be cost-effective compared with matched unrelated transplant.
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Sawamoto K, Chen HH, Alméciga-Díaz CJ, Mason RW, Tomatsu S. Gene therapy for Mucopolysaccharidoses. Mol Genet Metab 2018; 123:59-68. [PMID: 29295764 PMCID: PMC5986190 DOI: 10.1016/j.ymgme.2017.12.434] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/20/2017] [Accepted: 12/21/2017] [Indexed: 12/19/2022]
Abstract
Mucopolysaccharidoses (MPS) are a group of lysosomal storage disorders (LSDs) caused by a deficiency of lysosomal enzymes, leading to a wide range of various clinical symptoms depending upon the type of MPS or its severity. Enzyme replacement therapy (ERT), hematopoietic stem cell transplantation (HSCT), substrate reduction therapy (SRT), and various surgical procedures are currently available for patients with MPS. However, there is no curative treatment for this group of disorders. Gene therapy should be a one-time permanent therapy, repairing the cause of enzyme deficiency. Preclinical studies of gene therapy for MPS have been developed over the past three decades. Currently, clinical trials of gene therapy for some types of MPS are ongoing in the United States, some European countries, and Australia. Here, in this review, we summarize the development of gene therapy for MPS in preclinical and clinical trials.
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Affiliation(s)
- Kazuki Sawamoto
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, United States
| | - Hui-Hsuan Chen
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, United States; Department of Medical Laboratory Sciences, University of Delaware, Newark, DE, United States
| | - Carlos J Alméciga-Díaz
- Institute for the Study of Inborn Errors of Metabolism, Pontificia Universidad Javeriana, Bogotá D.C., Colombia
| | - Robert W Mason
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, United States
| | - Shunji Tomatsu
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, United States; Department of Pediatrics, Gifu University, Gifu, Japan; Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA, United States.
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The need to support caregivers during pediatric bone marrow transplantation (BMT): A case report. Palliat Support Care 2018; 16:367-370. [PMID: 29380715 DOI: 10.1017/s1478951517001018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTObjective:Pediatric bone marrow transplants represent a medically stressful, potentially traumatic experience for children and caregivers, and psychological support for parental caregivers is paramount to their long-term well-being. However, many medical centers do not have protocols in place to sustain caregiver well-being during these distressing experiences. METHOD We report on a case of a 10-month-old infant with Wiskott Aldrich Syndrome who was hospitalized for bone marrow transplantation. RESULT We describe the significant burden that fell upon caregivers during and after a bone marrow transplantation. SIGNIFICANCE OF RESULTS This case helped guide our suggestions to improve care for caregivers. Several logistical hurdles could be overcome to alleviate some of these burdens. We suggest that a child psychologist or psychiatrist should be on patient care teams and be attentive to parental stress, impairments, or impediments to self-care, and signs of emergency of mental illness in this setting of medical trauma. Additionally, promotion of sleep hygiene and linkage to support systems can maximize resiliency. Finally, we believe that hospital administrators should partner with clinicians to facilitate routine support during highly stressful transitions of care.
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Nivison-Smith I, Milliken S, Dodds AJ, Gottlieb D, Kwan J, Ma DD, Shaw PJ, Tran S, Wilcox L, Szer J. Activity and Capacity Profile of Transplant Physicians and Centers in Australia and New Zealand. Biol Blood Marrow Transplant 2018; 24:169-174. [DOI: 10.1016/j.bbmt.2017.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/18/2017] [Indexed: 10/18/2022]
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Bonafede M, Richhariya A, Cai Q, Josephson NC, McMorrow D, Garfin PM, Perales MA. Real-world economic burden of hematopoietic cell transplantation among a large US commercially insured population with hematologic malignancies. J Med Econ 2017; 20:1244-1251. [PMID: 28782449 DOI: 10.1080/13696998.2017.1364648] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIMS Approximately 20,000 hematopoietic cell transplantation (HCT) procedures are performed in the US annually. This study aims to study the healthcare resource utilization and costs among commercially-insured patients with hematologic malignancies who received autologous HCT (auto-HCT) and allogeneic HCT (allo-HCT) in the US. MATERIALS AND METHODS Adult patients with hematologic malignancies undergoing auto- or allo-HCT between January 1, 2011 and June 30, 2014 were identified in the Truven Health MarketScan Research Databases. Patients with 12 months of continuous pharmacy and medical enrollment pre- and post-HCT were included. Patients with prior HCT were excluded. Controls were selected from patients without any claims for HCT and matched with HCT recipients in a 3:1 ratio based on age, gender, insurance type, and Deyo-Charlson Comorbidity Index categories. Total healthcare resource uses and costs were compared between auto- or allo-HCT recipients and controls. RESULTS In total, 10,527 patients (HCT, n = 2,672 vs control, n = 7,855) were included, with the majority of HCT recipients (63.6%) undergoing auto-HCT. During the 6-month pre-index and 12-month post-index period, auto-HCT recipients incurred $313,562 (p < .01) higher all-cause costs than controls, attributable to inpatient admission (54.1%), outpatient services (33.4%), and prescriptions (12.5%). The all-cause costs for allo-HCT recipients were $621,895 (p < .01) higher vs controls during the 18-month observation period, attributable to inpatient admissions (75.5%), outpatient services (22.1%), and prescriptions (2.4%). CONCLUSIONS The use of HCT among patients with hematologic malignancies is associated with considerable economic burden in direct healthcare costs in a commercially insured population. Incremental costs for HCT recipients were mainly driven by costs related to hospitalization and other medical services.
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Affiliation(s)
- Machaon Bonafede
- a Truven Health Analytics, an IBM company , Cambridge , MA , USA
| | | | - Qian Cai
- a Truven Health Analytics, an IBM company , Cambridge , MA , USA
| | | | - Donna McMorrow
- a Truven Health Analytics, an IBM company , Cambridge , MA , USA
| | - Phillip M Garfin
- c Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Department of Medicine , Weill Cornell Medical College , New York , NY , USA
| | - Miguel-Angel Perales
- c Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Department of Medicine , Weill Cornell Medical College , New York , NY , USA
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Immunotherapy: Tisagenlecleucel - the first approved CAR-T-cell therapy: implications for payers and policy makers. Nat Rev Clin Oncol 2017; 15:11-12. [PMID: 28975930 DOI: 10.1038/nrclinonc.2017.156] [Citation(s) in RCA: 156] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Broder MS, Quock TP, Chang E, Reddy SR, Agarwal-Hashmi R, Arai S, Villa KF. The Cost of Hematopoietic Stem-Cell Transplantation in the United States. AMERICAN HEALTH & DRUG BENEFITS 2017; 10:366-374. [PMID: 29263771 PMCID: PMC5726064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 08/08/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Hematopoietic stem-cell transplantation (HSCT) requires highly specialized, resource-intensive care. Myeloablative conditioning regimens used before HSCT generally require inpatient stays and are more intensive than other preparative regimens, and may therefore be more costly. OBJECTIVE To estimate the costs associated with inpatient HSCT according to the type of the conditioning regimen used and other potential contributors to the overall cost of the procedure. METHOD We used data from the Truven Health MarketScan insurance claims database to analyze healthcare costs for pediatric (age <18 years) and adult (age ≥18 years) patients who had autologous or allogeneic inpatient HSCT between January 1, 2010, and September 23, 2013. We developed an algorithm to determine whether conditioning regimens were myeloablative or nonmyeloablative/reduced intensity. RESULTS We identified a sample of 1562 patients who had inpatient HSCT during the study period for whom the transplant type and the conditioning regimen were determinable: 398 patients had myeloablative allogeneic HSCT; 195 patients had nonmyeloablative/reduced-intensity allogeneic HSCT; and 969 patients had myeloablative autologous HSCT. The median total healthcare cost at 100 days was $289,283 for the myeloablative allogeneic regimen cohort compared with $253,467 for the nonmyeloablative/reduced-intensity allogeneic regimen cohort, and $140,792 for the myeloablative autologous regimen cohort. The mean hospital length of stay for the index (first claim of) HSCT was 35.6 days in the myeloablative allogeneic regimen cohort, 26.6 days in the nonmyeloablative/reduced-intensity allogeneic cohort, and 21.8 days in the myeloablative autologous regimen cohort. CONCLUSION Allogeneic HSCT was more expensive than autologous HSCT, regardless of the regimen used. Myeloablative conditioning regimens led to higher overall costs than nonmyeloablative/reduced-intensity regimens in the allogeneic HSCT cohort, indicating a greater cost burden associated with inpatient services for higher-intensity preparative conditioning regimens. Pediatric patients had higher costs than adult patients. Future research should involve validating the algorithm for identifying conditioning regimens using clinical data.
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Affiliation(s)
- Michael S Broder
- President and CEO, Partnership for Health Analytic Research, Beverly Hills, CA
| | - Tiffany P Quock
- Associate Director, Health Economics & Outcomes Research, Jazz Pharmaceuticals, Palo Alto, CA, during this study
| | - Eunice Chang
- Chief Statistician, Partnership for Health Analytic Research
| | - Sheila R Reddy
- Director, Health Services Research, Partnership for Health Analytic Research
| | - Rajni Agarwal-Hashmi
- Associate Professor, Pediatrics (Stem Cell Transplantation), Stanford University School of Medicine, Palo Alto, CA
| | - Sally Arai
- Associate Professor, Medicine (Blood and Marrow Transplantation), Stanford University School of Medicine
| | - Kathleen F Villa
- Executive Director, Health Economics & Outcomes Research, Jazz Pharmaceuticals
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Gajewski JL, McClellan MB, Majhail NS, Hari PN, Bredeson CN, Maziarz RT, LeMaistre CF, Lill MC, Farnia SH, Komanduri KV, Boo MJ. Payment and Care for Hematopoietic Cell Transplantation Patients: Toward a Specialized Medical Home for Complex Care Patients. Biol Blood Marrow Transplant 2017; 24:4-12. [PMID: 28963077 DOI: 10.1016/j.bbmt.2017.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 09/20/2017] [Indexed: 12/15/2022]
Abstract
Patient-centered medical home models are fundamental to the advanced alternative payment models defined in the Medicare Access and Children's Health Insurance Plan Reauthorization Act (MACRA). The patient-centered medical home is a model of healthcare delivery supported by alternative payment mechanisms and designed to promote coordinated medical care that is simultaneously patient-centric and population-oriented. This transformative care model requires shifting reimbursement to include a per-patient payment intended to cover services not previously reimbursed such as disease management over time. Payment is linked to quality measures, including proportion of care delivered according to predefined pathways and demonstrated impact on outcomes. Some medical homes also include opportunities for shared savings by reducing overall costs of care. Recent proposals have suggested expanding the medical home model to specialized populations with complex needs because primary care teams may not have the facilities or the requisite expertise for their unique needs. An example of a successful care model that may provide valuable lessons for those creating specialty medical home models already exists in many hematopoietic cell transplantation (HCT) centers that deliver multidisciplinary, coordinated, and highly specialized care. The integration of care delivery in HCT centers has been driven by the specialty care their patients require and by the payment methodology preferred by the commercial payers, which has included bundling of both inpatient and outpatient care in the peritransplant interval. Commercial payers identify qualified HCT centers based on accreditation status and comparative performance, enabled in part by center-level comparative performance data available within a national outcomes database mandated by the Stem Cell Therapeutic and Research Act of 2005. Standardization across centers has been facilitated via voluntary accreditation implemented by Foundation for the Accreditation of Cell Therapy. Payers have built on these community-established programs and use public outcomes and program accreditation as standards necessary for inclusion in specialty care networks and contracts. Although HCT centers have not been described as medical homes, most HCT providers have already developed the structures that address critical requirements of MACRA for medical homes.
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Affiliation(s)
- James L Gajewski
- Department of Health Policy and Strategic Relations, American Society for Blood and Marrow Transplantation, Chicago, Illinois.
| | - Mark B McClellan
- Duke University Margolis Center for Health Policy, Durham, North Carolina
| | - Navneet S Majhail
- Blood and Marrow Transplant Program, Division of Hematology & Medical Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Parameswaran N Hari
- Center for International Blood and Marrow Transplantation Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Richard T Maziarz
- Stem Cell Transplantation Program, Division of Hematology & Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | | | - Michael C Lill
- Stem Cell and Bone Marrow Transplant Program, Division of Hematology and Medical Oncology, Samuel Oschin Comprehensive Cancer Center, Los Angeles, California
| | - Stephanie H Farnia
- Department of Health Policy and Strategic Relations, American Society for Blood and Marrow Transplantation, Chicago, Illinois
| | - Krishna V Komanduri
- Adult Hematopoietic Stem Cell Transplant Program, Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Michael J Boo
- National Marrow Donor Program, Minneapolis, Minnesota
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Maziarz RT, Hao Y, Guerin A, Gauthier G, Gauthier-Loiselle M, Thomas SK, Eldjerou L. Economic burden following allogeneic hematopoietic stem cell transplant in patients with diffuse large B-cell lymphoma. Leuk Lymphoma 2017; 59:1133-1142. [DOI: 10.1080/10428194.2017.1375100] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Richard T. Maziarz
- Center for Hematologic Malignancies, Knight Cancer Institute Oregon Health & Science University (OHSU), Portland, OR, USA
| | - Yanni Hao
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | | | - Simu K. Thomas
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Lamis Eldjerou
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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Cao Z, Villa KF, Lipkin CB, Robinson SB, Nejadnik B, Dvorak CC. Burden of illness associated with sinusoidal obstruction syndrome/veno-occlusive disease in patients with hematopoietic stem cell transplantation. J Med Econ 2017; 20:871-883. [PMID: 28562132 DOI: 10.1080/13696998.2017.1336623] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AIMS Sinusoidal obstruction syndrome (SOS) is a life-threatening complication of hematopoietic stem cell transplantation (HSCT) associated with significant morbidity and mortality. Healthcare utilization, costs, and mortality were assessed in HSCT patients diagnosed with SOS, with and without multi-organ dysfunction (MOD). MATERIALS AND METHODS This retrospective observational study identified real-world patients undergoing HSCT between January 1, 2009 and May 31, 2014 using the Premier Healthcare Database. In absence of a formal ICD-9-CM diagnostic code, SOS patients were identified using a pre-specified definition adapted from Baltimore and Seattle criteria and clinical practice. Severe SOS (SOS/MOD) and non-severe SOS (SOS/no-MOD) were classified according to clinical evidence for MOD in the database. RESULTS Of the 5,418 patients with a discharge diagnosis of HSCT, 291 had SOS, with 134 categorized as SOS/MOD and 157 as SOS/no-MOD. The remaining 5,127 patients had HSCT without SOS. Overall SOS incidence was 5.4%, with 46% having evidence of MOD. Distribution of age, gender, and race were similar between the SOS cohorts and non-SOS patients. After controlling for hospital profile and admission characteristics, demographics, and clinical characteristics, the adjusted mean LOS was 31.0 days in SOS/MOD compared to 23.9 days in the non-SOS cohort (medians = 26.9 days vs 20.8 days, p < .001). The adjusted mean cost of SOS/MOD patients was $140,653, which was $41,702 higher than the non-SOS cohort (medians = $105,749 vs $74,395, p < .001). An almost 6-fold increased odds of inpatient mortality was associated with SOS/MOD compared to the non-SOS cohort (odds ratio = 5.88; 95% CI = 3.45-10.33). LIMITATIONS Limitations of retrospective observational studies apply, since the study was not randomized. Definition for SOS was based on ICD-9 diagnosis codes from a hospital administrative database and reliant on completeness and accuracy of coding. CONCLUSIONS Analysis of real-world data shows that SOS/MOD is associated with significant increases in healthcare utilization, costs, and inpatient mortality.
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Affiliation(s)
- Zhun Cao
- a Premier Research Services , Charlotte , NC , USA
| | | | | | | | | | - Christopher C Dvorak
- d Benioff Children's Hospital, University of California San Francisco , San Francisco , CA , USA
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Perales MA, Bonafede M, Cai Q, Garfin PM, McMorrow D, Josephson NC, Richhariya A. Real-World Economic Burden Associated with Transplantation-Related Complications. Biol Blood Marrow Transplant 2017; 23:1788-1794. [PMID: 28688917 DOI: 10.1016/j.bbmt.2017.06.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 06/20/2017] [Indexed: 12/29/2022]
Abstract
Approximately 20,000 hematopoietic cell transplantation (HCT) procedures are performed annually in the United States. Real-world data on the costs associated with post-transplantation complications are limited. Patients with hematologic malignancies aged ≥18 years undergoing autologous HCT (auto-HCT) or allogeneic HCT (allo-HCT) between January 1, 2011, and June 30, 2014, were identified in the Truven Health MarketScan Research Databases. Patients were required to have 12 months of continuous medical and pharmacy enrollment before and after HCT; patients who experience inpatient death within 12 months post-HCT were also included. Patients with previous HCT were excluded. Potential HCT-related complications were identified if they had a medical claim with a diagnosis code for relapse; infection; cardiovascular, renal, neurologic, pulmonary, hepatic, or gastrointestinal disease; secondary malignancy; thrombotic microangiopathy; or posterior reversible encephalopathy syndrome within 1 year post-HCT. Healthcare costs attributable to these complications were evaluated by comparing total costs in HCT recipients with complications and those without complications. The MarketScan Research Databases were further linked to the Social Security Administration's Master Death File to obtain patient death events in a subset of patients. A total of 2672 HCT recipients were included in the analysis. The mean ± SD age of recipients was 54.5 ± 11.6 years, and the majority of recipients (63.6%) underwent auto-HCT. Complications were identified in 81% of auto-HCT recipients and in 95.5% of allo-HCT recipients. Most complications occurred within 180 days post-HCT. Compared with Auto-HCT recipients without complications, those with complications incurred $51,475 higher adjusted total costs (P < .01). Compared with allo-HCT recipients without complications, those with complications incurred $181,473 higher adjusted total costs (P < .01). Among the patients with mortality data, auto-HCT recipients with complications had a higher mortality rate (13.4% vs 5.7%, P < .01) and a lower probability of survival (P < .01) compared with those without complications. In allo-HCT recipients, however, the mortality rate and probability of survival were not significantly different between those with complications and those without complications. HCT recipients with complications were associated with considerable economic burden in terms of direct healthcare costs in a commercially insured population, and in the case of auto-HCT, a higher mortality rate was observed in those with complications.
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Affiliation(s)
- Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Department of Medicine, Weill Cornell Medical College, New York, New York
| | | | - Qian Cai
- Truven Health Analytics, Cambridge, Massachusetts.
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Martino M, Console G, Russo L, Meliado' A, Meliambro N, Moscato T, Irrera G, Messina G, Pontari A, Morabito F. Autologous Stem Cell Transplantation in Patients With Multiple Myeloma: An Activity-based Costing Analysis, Comparing a Total Inpatient Model Versus an Early Discharge Model. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017. [PMID: 28647402 DOI: 10.1016/j.clml.2017.05.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Activity-based costing (ABC) was developed and advocated as a means of overcoming the systematic distortions of traditional cost accounting. MATERIALS AND METHODS We calculated the cost of high-dose chemotherapy and autologous stem cell transplantation (ASCT) in patients with multiple myeloma using the ABC method, through 2 different care models: the total inpatient model (TIM) and the early-discharge outpatient model (EDOM) and compared this with the approved diagnosis related-groups (DRG) Italian tariffs. RESULTS The TIM and EDOM models involved a total cost of €28,615.15 and €16,499.43, respectively. In the TIM model, the phase with the greatest economic impact was the posttransplant (recovery and hematologic engraftment) with 36.4% of the total cost, whereas in the EDOM model, the phase with the greatest economic impact was the pretransplant (chemo-mobilization, apheresis procedure, cryopreservation, and storage) phase, with 60.4% of total expenses. In an analysis of each episode, the TIM model comprised a higher absorption than the EDOM. In particular, the posttransplant represented 36.4% of the total costs in the TIM and 17.7% in EDOM model, respectively. The estimated reduction in cost per patient using an EDOM model was over €12,115.72. The repayment of the DRG in Calabrian Region for the ASCT procedure is €59,806. Given the real cost of the transplant, the estimated cost saving per patient is €31,190.85 in the TIM model and €43,306.57 in the EDOM model. CONCLUSION In conclusion, the actual repayment of the DRG does not correspond to the real cost of the ASCT procedure in Italy. Moreover, using the EDOM, the cost of ASCT is approximately the half of the TIM model.
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Affiliation(s)
- Massimo Martino
- Hematology, Stem Cell Collection, and Transplant Unit, Oncology and Hematology Department, Azienda Ospedaliera BMM, Reggio Calabria, Italy.
| | - Giuseppe Console
- Hematology, Stem Cell Collection, and Transplant Unit, Oncology and Hematology Department, Azienda Ospedaliera BMM, Reggio Calabria, Italy
| | - Letteria Russo
- Hematology, Stem Cell Collection, and Transplant Unit, Oncology and Hematology Department, Azienda Ospedaliera BMM, Reggio Calabria, Italy
| | - Antonella Meliado'
- Hematology, Stem Cell Collection, and Transplant Unit, Oncology and Hematology Department, Azienda Ospedaliera BMM, Reggio Calabria, Italy
| | - Nicola Meliambro
- Hematology, Stem Cell Collection, and Transplant Unit, Oncology and Hematology Department, Azienda Ospedaliera BMM, Reggio Calabria, Italy
| | - Tiziana Moscato
- Hematology, Stem Cell Collection, and Transplant Unit, Oncology and Hematology Department, Azienda Ospedaliera BMM, Reggio Calabria, Italy
| | - Giuseppe Irrera
- Hematology, Stem Cell Collection, and Transplant Unit, Oncology and Hematology Department, Azienda Ospedaliera BMM, Reggio Calabria, Italy
| | - Giuseppe Messina
- Hematology, Stem Cell Collection, and Transplant Unit, Oncology and Hematology Department, Azienda Ospedaliera BMM, Reggio Calabria, Italy
| | - Antonella Pontari
- Hematology, Stem Cell Collection, and Transplant Unit, Oncology and Hematology Department, Azienda Ospedaliera BMM, Reggio Calabria, Italy
| | - Fortunato Morabito
- Hematology Unit, Azienda Ospedaliera Cosenza, Cosenza, Italy; Biotechnology Research Unit, Azienda Sanitaria Provinciale di Cosenza, Aprigliano (CS), Italy
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Farnia S, Ganetsky A, Silver A, Hwee T, Preussler J, Griffin J, Khera N. Challenges around Access to and Cost of Life-Saving Medications after Allogeneic Hematopoietic Cell Transplantation for Medicare Patients. Biol Blood Marrow Transplant 2017; 23:1387-1392. [PMID: 28412517 DOI: 10.1016/j.bbmt.2017.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 04/09/2017] [Indexed: 12/16/2022]
Abstract
Hematopoietic cell transplantation (HCT) is an expensive, medically complicated, and potentially life-threatening therapy for multiple hematologic and nonhematologic disorders with a prolonged trajectory of recovery. Similar to financial issues in other cancer treatments, adverse financial consequences of HCT are emerging as an important issue and may be associated with poor quality of life and increased distress in HCT survivors. Prescription medicine coverage for HCT for Medicare and some Medicaid beneficiaries, especially in the long-term, remains suboptimal because of inadequate payer formularies or prohibitive copays. With an increasing number of older patients undergoing HCT and improvement in the overall survival after HCT, the problem of financial burden faced by Medicare beneficiaries with fixed incomes is going to worsen. In this article, we describe the typical financial burden borne by HCT recipients based on estimated copayment amounts attached to the categories of key medications as elucidated through 2 case studies. We also suggest some possible solutions for consideration to help these patients and families get through the HCT by minimizing the financial burden from essential medications needed during the post-HCT period.
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Affiliation(s)
- Stephanie Farnia
- Health Policy and Strategic Relations, American Society for Blood and Marrow Transplantation, Arlington Heights, Illinois
| | - Alex Ganetsky
- Blood and Marrow Transplantation Program, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alicia Silver
- Payer Policy and Legislative Relations, National Marrow Donor Program, Minneapolis, Minnesota
| | - Theresa Hwee
- Payer Policy and Legislative Relations, National Marrow Donor Program, Minneapolis, Minnesota
| | - Jaime Preussler
- Payer Policy and Legislative Relations, National Marrow Donor Program, Minneapolis, Minnesota
| | - Joan Griffin
- Division of Health Care Policy and Research, Kern Center for the Science of Health Care Delivery, Mayo Clinic Rochester, Rochester, Minnesota
| | - Nandita Khera
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona.
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Das L, Gitlin M, Siegartel LR, Makenbaeva D. The value of open access and a patient centric approach to oral oncolytic utilization in the treatment of Chronic Myelogenous Leukemia: A U.S. perspective. Expert Rev Pharmacoecon Outcomes Res 2017; 17:133-140. [PMID: 28287008 DOI: 10.1080/14737167.2017.1305892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Since the introduction of tyrosine kinase inhibitors (TKIs), the treatment of patients with chronic myelogenous leukemia (CML) has resulted in significant improvement in patient survival but at a higher pharmaceutical cost to payers. The recent introduction of generic imatinib presents an opportunity to lower pharmacy costs within a population that is growing due to improved survival. Recent literature has focused on the likely benefits to payers of step therapy through generic imatinib. Areas covered: This review provides a perspective that is broader than the evaluation of financial savings or narrowly defined health economic metrics by incorporating factors such as CML patient heterogeneity, including varying levels of disease progression risk, comorbidities and genetic mutation status, differences in TKI product profiles, clinical guideline recommendations, and the importance of individualized patient care. A focused literature review evaluating the real-world impact of utilization management programs is presented. Expert commentary: The findings indicate that payers can achieve substantial savings without the need to implement utilization management policies. Compromises in the ability to provide individualized patient care and unwanted economic consequences resulting from increased costs of disease progression, adverse events, and lack of response to treatment due to utilization management are summarized.
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Affiliation(s)
| | | | - Lisa R Siegartel
- b Health Economics and Outcomes Research - US Medical , Bristol-Myers Squibb Company , Princeton , NJ , USA
| | - Dinara Makenbaeva
- b Health Economics and Outcomes Research - US Medical , Bristol-Myers Squibb Company , Princeton , NJ , USA
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93
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Preussler JM, Meyer CL, Mau LW, Majhail NS, Denzen EM, Edsall KC, Farnia SH, Saber W, Burns LJ, Vanness DJ. Healthcare Costs and Utilization for Patients Age 50 to 64 Years with Acute Myeloid Leukemia Treated with Chemotherapy or with Chemotherapy and Allogeneic Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2017; 23:1021-1028. [PMID: 28263920 DOI: 10.1016/j.bbmt.2017.02.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 02/27/2017] [Indexed: 10/20/2022]
Abstract
The primary aim of this study was to describe healthcare costs and utilization during the first year after a diagnosis of acute myeloid leukemia (AML) for privately insured non-Medicare patients in the United States aged 50 to 64 years who were treated with either chemotherapy or chemotherapy and allogeneic hematopoietic cell transplantation (alloHCT). MarketScan (Truven Health Analytics) adjudicated total payments for inpatient, outpatient, and prescription drug claims from 2007 to 2011 were used to estimate costs from the health system perspective. Stabilized inverse propensity score weights were constructed using logistic regression to account for differential selection of alloHCT over chemotherapy. Weighted generalized linear models adjusted costs and utilization (hospitalizations, inpatient days, and outpatient visit-days) for differences in age, sex, diagnosis year, region, insurance plan type, Elixhauser Comorbidity Index), and 60-day prediagnosis costs. Because mortality data were not available, models could not be adjusted for survival times. Among 29,915 patients with a primary diagnosis of AML, 985 patients met inclusion criteria (774 [79%] receiving chemotherapy alone and 211 [21%] alloHCT). Adjusted mean 1-year costs were $280,788 for chemotherapy and $544,178 for alloHCT. Patients receiving chemotherapy alone had a mean of 4 hospitalizations, 52.9 inpatient days, and 52.4 outpatient visits in the year after AML diagnosis; patients receiving alloHCT had 5 hospitalizations, 92.5 inpatient days, and 74.5 outpatient visits. Treating AML in the first year after diagnosis incurs substantial healthcare costs and utilization with chemotherapy alone and with alloHCT. Our analysis informs healthcare providers, policymakers, and payers so they can better understand treatment costs and utilization for privately insured patients aged 50 to 64 with AML.
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Affiliation(s)
| | - Christa L Meyer
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Lih-Wen Mau
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Navneet S Majhail
- Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio
| | - Ellen M Denzen
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Kristen C Edsall
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | | | - Wael Saber
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Linda J Burns
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - David J Vanness
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, Wisconsin.
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94
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Olin JL, Canupp K, Smith MB. New Pharmacotherapies in Chronic Lymphocytic Leukemia. P & T : A PEER-REVIEWED JOURNAL FOR FORMULARY MANAGEMENT 2017; 42:106-115. [PMID: 28163556 PMCID: PMC5265236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The authors present the clinical outcomes and therapeutic application of newly approved pharmacotherapies for chronic lymphocytic leukemia and highlight emerging investigational therapeutic options.
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95
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Chen Q, Jain N, Ayer T, Wierda WG, Flowers CR, O'Brien SM, Keating MJ, Kantarjian HM, Chhatwal J. Economic Burden of Chronic Lymphocytic Leukemia in the Era of Oral Targeted Therapies in the United States. J Clin Oncol 2016; 35:166-174. [PMID: 27870563 DOI: 10.1200/jco.2016.68.2856] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Purpose Oral targeted therapies represent a significant advance for the treatment of patients with chronic lymphocytic leukemia (CLL); however, their high cost has raised concerns about affordability and the economic impact on society. Our objective was to project the future prevalence and cost burden of CLL in the era of oral targeted therapies in the United States. Methods We developed a simulation model that evaluated the evolving management of CLL from 2011 to 2025: chemoimmunotherapy (CIT) as the standard of care before 2014, oral targeted therapies for patients with del(17p) and relapsed CLL from 2014, and for first-line treatment from 2016 onward. A comparator scenario also was simulated where CIT remained the standard of care throughout. Disease progression and survival parameters for each therapy were based on published clinical trials. Results The number of people living with CLL in the United States is projected to increase from 128,000 in 2011 to 199,000 by 2025 (55% increase) due to improved survival; meanwhile, the annual cost of CLL management will increase from $0.74 billion to $5.13 billion (590% increase). The per-patient lifetime cost of CLL treatment will increase from $147,000 to $604,000 (310% increase) as oral targeted therapies become the first-line treatment. For patients enrolled in Medicare, the corresponding total out-of-pocket cost will increase from $9,200 to $57,000 (520% increase). Compared with the CIT scenario, oral targeted therapies resulted in an incremental cost-effectiveness ratio of $189,000 per quality-adjusted life-year. Conclusion The increased benefit and cost of oral targeted therapies is projected to enhance CLL survivorship but can impose a substantial financial burden on both patients and payers. More sustainable pricing strategies for targeted therapies are needed to avoid financial toxicity to patients.
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Affiliation(s)
- Qiushi Chen
- Qiushi Chen and Turgay Ayer, Georgia Institute of Technology; Christopher R. Flowers, Emory University, Atlanta, GA; Qiushi Chen and Jagpreet Chhatwal, Massachusetts General Hospital; Jagpreet Chhatwal, Harvard Medical School, Boston, MA; Nitin Jain, William G. Wierda, Michael J. Keating, and Hagop M. Kantarjian, The University of Texas MD Anderson Cancer Center, Houston, TX; and Susan M. O'Brien, University of California Irvine Medical Center, Orange, CA
| | - Nitin Jain
- Qiushi Chen and Turgay Ayer, Georgia Institute of Technology; Christopher R. Flowers, Emory University, Atlanta, GA; Qiushi Chen and Jagpreet Chhatwal, Massachusetts General Hospital; Jagpreet Chhatwal, Harvard Medical School, Boston, MA; Nitin Jain, William G. Wierda, Michael J. Keating, and Hagop M. Kantarjian, The University of Texas MD Anderson Cancer Center, Houston, TX; and Susan M. O'Brien, University of California Irvine Medical Center, Orange, CA
| | - Turgay Ayer
- Qiushi Chen and Turgay Ayer, Georgia Institute of Technology; Christopher R. Flowers, Emory University, Atlanta, GA; Qiushi Chen and Jagpreet Chhatwal, Massachusetts General Hospital; Jagpreet Chhatwal, Harvard Medical School, Boston, MA; Nitin Jain, William G. Wierda, Michael J. Keating, and Hagop M. Kantarjian, The University of Texas MD Anderson Cancer Center, Houston, TX; and Susan M. O'Brien, University of California Irvine Medical Center, Orange, CA
| | - William G Wierda
- Qiushi Chen and Turgay Ayer, Georgia Institute of Technology; Christopher R. Flowers, Emory University, Atlanta, GA; Qiushi Chen and Jagpreet Chhatwal, Massachusetts General Hospital; Jagpreet Chhatwal, Harvard Medical School, Boston, MA; Nitin Jain, William G. Wierda, Michael J. Keating, and Hagop M. Kantarjian, The University of Texas MD Anderson Cancer Center, Houston, TX; and Susan M. O'Brien, University of California Irvine Medical Center, Orange, CA
| | - Christopher R Flowers
- Qiushi Chen and Turgay Ayer, Georgia Institute of Technology; Christopher R. Flowers, Emory University, Atlanta, GA; Qiushi Chen and Jagpreet Chhatwal, Massachusetts General Hospital; Jagpreet Chhatwal, Harvard Medical School, Boston, MA; Nitin Jain, William G. Wierda, Michael J. Keating, and Hagop M. Kantarjian, The University of Texas MD Anderson Cancer Center, Houston, TX; and Susan M. O'Brien, University of California Irvine Medical Center, Orange, CA
| | - Susan M O'Brien
- Qiushi Chen and Turgay Ayer, Georgia Institute of Technology; Christopher R. Flowers, Emory University, Atlanta, GA; Qiushi Chen and Jagpreet Chhatwal, Massachusetts General Hospital; Jagpreet Chhatwal, Harvard Medical School, Boston, MA; Nitin Jain, William G. Wierda, Michael J. Keating, and Hagop M. Kantarjian, The University of Texas MD Anderson Cancer Center, Houston, TX; and Susan M. O'Brien, University of California Irvine Medical Center, Orange, CA
| | - Michael J Keating
- Qiushi Chen and Turgay Ayer, Georgia Institute of Technology; Christopher R. Flowers, Emory University, Atlanta, GA; Qiushi Chen and Jagpreet Chhatwal, Massachusetts General Hospital; Jagpreet Chhatwal, Harvard Medical School, Boston, MA; Nitin Jain, William G. Wierda, Michael J. Keating, and Hagop M. Kantarjian, The University of Texas MD Anderson Cancer Center, Houston, TX; and Susan M. O'Brien, University of California Irvine Medical Center, Orange, CA
| | - Hagop M Kantarjian
- Qiushi Chen and Turgay Ayer, Georgia Institute of Technology; Christopher R. Flowers, Emory University, Atlanta, GA; Qiushi Chen and Jagpreet Chhatwal, Massachusetts General Hospital; Jagpreet Chhatwal, Harvard Medical School, Boston, MA; Nitin Jain, William G. Wierda, Michael J. Keating, and Hagop M. Kantarjian, The University of Texas MD Anderson Cancer Center, Houston, TX; and Susan M. O'Brien, University of California Irvine Medical Center, Orange, CA
| | - Jagpreet Chhatwal
- Qiushi Chen and Turgay Ayer, Georgia Institute of Technology; Christopher R. Flowers, Emory University, Atlanta, GA; Qiushi Chen and Jagpreet Chhatwal, Massachusetts General Hospital; Jagpreet Chhatwal, Harvard Medical School, Boston, MA; Nitin Jain, William G. Wierda, Michael J. Keating, and Hagop M. Kantarjian, The University of Texas MD Anderson Cancer Center, Houston, TX; and Susan M. O'Brien, University of California Irvine Medical Center, Orange, CA
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96
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Cost Implications of Comorbidity for Autologous Stem Cell Transplantation in Elderly Patients with Multiple Myeloma Using SEER-Medicare. BONE MARROW RESEARCH 2016; 2016:3645623. [PMID: 27830092 PMCID: PMC5088316 DOI: 10.1155/2016/3645623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 09/28/2016] [Indexed: 11/23/2022]
Abstract
Comorbidity is more common in older patients and can increase the cost of care by increasing toxicity. Using the SEER-Medicare database from 2000 to 2007, we examined the costs and life-year benefit of Auto-HSCT for MM patients over the age of 65 by evaluating the difference over time relative to comorbidity burden. One hundred ten patients had an Auto-HSCT in the early time period (2000–2003) and 160 in the late time period (2004–2007). Patients were divided by a Charlson Comorbidity Index (CCI) of 0 or greater than 1 (CCI1+). Median overall survival was 53.5 months for the late time period patients compared to 40.3 months for the early time period patients (p = 0.031). Median costs for CCI0 versus CCI1+ in the early period were, respectively, $70,900 versus $72,000 (100 d); $86,100 versus $98,300 (1 yr); and $139,200 versus $195,300 (3 yrs). Median costs for late period were, respectively, $58,400 versus $60,400 (100 d); $86,300 versus $77,700 (1 yr); and $124,400 versus $110,900 (3 yrs). Comorbidity had a significant impact on survival and cost among early time period patients but not among late time period patients. Therefore, older patients with some comorbidities can be considered for Auto-HSCT depending on clinical circumstances.
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97
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Preussler JM, Mau LW, Majhail NS, Meyer CL, Denzen EM, Edsall KC, Farnia SH, Silver A, Saber W, Burns LJ, Vanness DJ. Administrative Claims Data for Economic Analyses in Hematopoietic Cell Transplantation: Challenges and Opportunities. Biol Blood Marrow Transplant 2016; 22:1738-1746. [PMID: 27184624 PMCID: PMC5600540 DOI: 10.1016/j.bbmt.2016.05.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 05/03/2016] [Indexed: 01/17/2023]
Abstract
There is an increasing need for the development of approaches to measure quality, costs, and resource utilization patterns among allogeneic hematopoietic cell transplantation (HCT) patients. Administrative claims data provide an opportunity to examine service utilization and costs, particularly from the payer's perspective. However, because administrative claims data are primarily designed for reimbursement purposes, challenges arise when using it for research. We use a case study with data derived from the 2007 to 2011 Truven Health MarketScan Research database to discuss opportunities and challenges for the use of administrative claims data to examine the costs and service utilization of allogeneic HCT and chemotherapy alone for patients with acute myeloid leukemia (AML). Starting with a cohort of 29,915 potentially eligible patients with a diagnosis of AML, we were able to identify 211 patients treated with HCT and 774 treated with chemotherapy alone where we were sufficiently confident of the diagnosis and treatment path to allow analysis. Administrative claims data provide an avenue to meet the need for health care costs, resource utilization, and outcome information. However, when using these data, a balance between clinical knowledge and applied methods is critical to identifying a valid study cohort and accurate measures of costs and resource utilization.
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Affiliation(s)
| | - Lih-Wen Mau
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota.
| | - Navneet S Majhail
- Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio
| | - Christa L Meyer
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Ellen M Denzen
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Kristen C Edsall
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | | | - Alicia Silver
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Wael Saber
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Linda J Burns
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
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98
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Liu HD. The Cost of Mobilization. Biol Blood Marrow Transplant 2016; 22:1735-1736. [PMID: 27538375 DOI: 10.1016/j.bbmt.2016.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 08/10/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Hien D Liu
- Taussig Cancer Institute, Department of Hematology/Medical Oncology, Cleveland Clinic Foundation, Cleveland, Ohio.
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99
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Chemaly RF, Aitken SL, Wolfe CR, Jain R, Boeckh MJ. Aerosolized ribavirin: the most expensive drug for pneumonia. Transpl Infect Dis 2016; 18:634-6. [PMID: 27214684 DOI: 10.1111/tid.12551] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 05/02/2016] [Accepted: 05/10/2016] [Indexed: 11/26/2022]
Abstract
Dramatic, overnight cost increases of important orphan and generic medications have recently come under public and government scrutiny. We highlight the case of aerosolized ribavirin, an important antiviral agent in hematopoietic stem cell transplantation which, because of substantial price increases, may now cost more than the transplant procedure itself.
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Affiliation(s)
- R F Chemaly
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - S L Aitken
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - C R Wolfe
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - R Jain
- School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - M J Boeckh
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,School of Medicine, University of Washington, Seattle, Washington, USA
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100
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Abel GA, Albelda R, Khera N, Hahn T, Salas Coronado DY, Odejide OO, Bona K, Tucker-Seeley R, Soiffer R. Financial Hardship and Patient-Reported Outcomes after Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2016; 22:1504-1510. [PMID: 27184627 DOI: 10.1016/j.bbmt.2016.05.008] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 05/04/2016] [Indexed: 12/16/2022]
Abstract
Although hematopoietic cell transplantation (HCT) is the only curative therapy for many advanced hematologic cancers, little is known about the financial hardship experienced by HCT patients nor the association of hardship with patient-reported outcomes. We mailed a 43-item survey to adult patients approximately 180 days after their first autologous or allogeneic HCT at 3 high-volume centers. We assessed decreases in household income; difficulty with HCT-related costs, such as need to relocate or travel; and 2 types of hardship: hardship_1 (reporting 1 or 2 of the following: dissatisfaction with present finances, difficulty meeting monthly bill payments, or not having enough money at the end of the month) and "hardship_2" (reporting all 3). Patient-reported stress was measured with the Perceived Stress Scale-4, and 7-point scales were provided for perceptions of overall quality of life (QOL) and health. In total, 325 of 499 surveys (65.1%) were received. The median days since HCT was 173; 47% underwent an allogeneic HCT, 60% were male, 51% were > 60 years old, and 92% were white. Overall, 46% reported income decline after HCT, 56% reported hardship_1, and 15% reported hardship_2. In multivariable models controlling for income, those reporting difficulty paying for HCT-related costs were more likely to report financial hardship (odds ratio, 6.9; 95% confidence interval, 3.8 to 12.3). Hardship_1 was associated with QOL below the median (odds ratio, 2.9; 95% confidence interval, 1.7 to 4.9), health status below the median (odds ratio, 2.2; 95% confidence interval, 1.3 to 3.6), and stress above the median (odds ratio, 2.1; 95% confidence interval, 1.3 to 3.5). In this sizable cohort of HCT patients, financial hardship was prevalent and associated with worse QOL and higher levels of perceived stress. Interventions to address patient financial hardship-especially those that ameliorate HCT-specific costs-are likely to improve patient-reported outcomes.
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Affiliation(s)
- Gregory A Abel
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts; Division of Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
| | - Randy Albelda
- Department of Economics, University of Massachusetts Boston, Boston, Massachusetts
| | - Nandita Khera
- Department of Oncology/Hematology, Mayo Clinic, Phoenix, Arizona
| | - Theresa Hahn
- Division of Blood and Marrow Transplant, Roswell Park Cancer Institute, Buffalo, New York
| | - Diana Y Salas Coronado
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Public Policy, University of Massachusetts, Boston, Massachusetts
| | - Oreofe O Odejide
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts; Division of Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kira Bona
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Robert Soiffer
- Division of Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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