Significant nationwide variability in the costs and hospital mortality rates of autologous stem cell transplantation for multiple myeloma: An analysis of the Nationwide Inpatient Sample database Journal Article


Authors: Liu, Y.; Han, H.; Shah, G.; Giralt, S.; Landgren, C. O.; He, J.; Lesokhin, A. M.
Article Title: Significant nationwide variability in the costs and hospital mortality rates of autologous stem cell transplantation for multiple myeloma: An analysis of the Nationwide Inpatient Sample database
Abstract: Autologous hematopoietic stem cell transplantation (AHCT) is the standard of care for eligible patients with multiple myeloma (MM). In this study, we explored disparities in hospital cost and in-hospital mortality among patients with MM who underwent AHCT. Data were obtained from the Nationwide Inpatient Sample database for 2005 to 2014. International Classification of Diseases, Ninth Edition, Clinical Modification diagnosis and procedure codes were used to identify patients. Hospitals were divided into quintiles according to the weighted volume of AHCTs performed in patients with MM. Multiple imputation with chained equation was used for missing data. Linear trend analysis of age- and sex-adjusted mortality, as well as inflation-adjusted hospital cost, was performed. Univariate regression screening followed by stepwise multivariate regression was performed for dependent variables, including mortality and inflation-adjusted hospital cost. Identified significant predictors underwent sensitivity analyses. Overall age- and sex-adjusted mortality rates and inflation-adjusted hospital costs decreased between 2005 and 2014; however, tremendous nationwide variability exists. Patients who underwent AHCT at very-low-volume hospitals (Q1) had significantly higher in-hospital mortality. Both geographic location and hospital type had impacted age- and sex-adjusted mortality rates and inflation-adjusted hospital costs. Despite an overall improvement in mortality and decreased cost of AHCT for patients with MM, nationwide variability in care exists. Further study is needed to identify correctable factors that contribute to the identified correlation. © 2018 Elsevier Ltd
Keywords: multiple myeloma; stem cell transplantation; healthcare disparity
Journal Title: Biology of Blood and Marrow Transplantation
Volume: 25
Issue: 1
ISSN: 1083-8791
Publisher: Elsevier Inc.  
Date Published: 2019-01-01
Start Page: 41
End Page: 46
Language: English
DOI: 10.1016/j.bbmt.2018.08.030
PROVIDER: scopus
PUBMED: 30195073
DOI/URL:
Notes: Biol. Blood Marrow Transplant. -- Export Date: 2 January 2019 -- Article -- CODEN: BBMTF -- Source: Scopus
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MSK Authors
  1. Sergio Andres Giralt
    499 Giralt
  2. Alexander Meyer Lesokhin
    106 Lesokhin
  3. Carl Ola Landgren
    175 Landgren
  4. Gunjan Lalitchandra Shah
    67 Shah