Economic analysis of unrelated allogeneic bone marrow transplantation: Results from the randomized clinical trial of T-cell depletion vs unmanipulated grafts for the prevention of graft-versus-host disease Journal Article


Authors: de Lissovoy, G.; Hurd, D.; Carter, S.; Beatty, P.; Ewell, M.; Henslee-Downey, J.; Kernan, N.; Yanovich, S.; Weisdorf, D.
Article Title: Economic analysis of unrelated allogeneic bone marrow transplantation: Results from the randomized clinical trial of T-cell depletion vs unmanipulated grafts for the prevention of graft-versus-host disease
Abstract: Unrelated-donor marrow transplantation is a potential option for transplant candidates lacking a compatible related donor. The T-cell Depletion Study compared the 3-year disease-free survival for patients receiving T-cell-depleted (TCD) donor marrow (n=203) vs unmanipulated donor marrow with methotrexate and cyclosporine (M/C) (n=207). Hospital costs during index admission were documented with billing data, while hospital costs during subsequent 6-month follow-up were estimated from case report forms. Patients with index admission billing were included in the analysis (TCD=119, M/C=127). Total hospital length of stay (LOS) was similar across groups, with medians 47.0 days for TCD and 52.0 days for M/C (P=0.72). Total hospital costs were comparable, $145 115 vs $141 981 (P=0.63) for TCD and M/C, respectively. However, controlling for site and patient characteristics, TCD was associated with a 12.1% reduction in LOS for the index admission (95% CI-19.4%, -4.3%). Independent of treatment, HLA matching (6/6) was associated with an 8.6% (95% CI -17.4%, +1.2%) reduction in the index admission LOS, while cost was lower by 15.8% (95% CI -26.7%, -3.3%). Treatment costs were similar for TCD and M/C study groups. Savings on reduced cost for treating acute graft-versus-host disease were likely offset by increase in serious infections in the TCD arm. © 2005 Nature Publishing Group All rights reserved.
Keywords: adolescent; adult; cancer survival; child; controlled study; child, preschool; middle aged; survival rate; transplantation, homologous; major clinical study; clinical trial; methotrexate; follow up; quality of life; controlled clinical trial; infection; randomized controlled trial; allogenic bone marrow transplantation; chronic myeloid leukemia; confidence interval; cost control; cost effectiveness analysis; health care cost; health economics; economics; length of stay; acute graft versus host disease; statistical analysis; statistical significance; infant; multicenter study; intermethod comparison; t cell depletion; cyclosporin a; bone marrow transplantation; graft vs host disease; hospital cost; cost-effectiveness; lymphocyte depletion; costs and cost analysis; t-cell depletion
Journal Title: Bone Marrow Transplantation
Volume: 36
Issue: 6
ISSN: 0268-3369
Publisher: Nature Publishing Group  
Date Published: 2005-09-01
Start Page: 539
End Page: 546
Language: English
DOI: 10.1038/sj.bmt.1705078
PUBMED: 16044144
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 9" - "Export Date: 24 October 2012" - "CODEN: BMTRE" - "Source: Scopus"
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  1. Nancy Kernan
    477 Kernan