Predicting mortality and cost of hematopoietic stem-cell transplantation.

OBJECTIVE: To evaluate whether the Pretransplantion Assesment of Mortality risk score is associated to transplant costs and can be used not only to predict mortality but also as a cost management tool. METHODS: We evaluated consecutively patients submitted to allogeneic (n = 27) and autologous (n = 89) hematopoietic stem cell-transplantation from 2004 to 2006 at Hospital Israelita Albert Einstein (SP), Brazil. Participants mean age at hematopoietic stem cell-transplantation was 42 (range 1 to 72) years; there were 69 males and 47 females; 30 patients had multiple myeloma; 41 had non-Hodgkin and Hodgkin's lymphomas; 22 had acute leukemia; 6 had chronic leukemia; and 17 had non-malignant disease. The Pretransplantion Assesment of Mortality risk score was applied in all patients using the available web site (http://cdsweb.fhcrc.org/ pam/). RESULTS: Patients could be classified in three risk categories: high, intermediate and low, having significant difference in survival (p = 0.0162). The median cost in US dollars for each group was $ 281.000, $ 73.300 and $ 54.400 for high, intermediate and low risk, respectively. The cost of hematopoietic stem cell-transplantation significantly differed for each Pretransplantin Assesment of Mortality risk group (p = 0.008). CONCLUSION: The validation of the Pretransplantion Assesment of Mortality risk score in our patients confirmed that this system is an important tool to be used in transplantation units, being easy to apply and fully reproducible.

The importance of a database in the management of healthcare services.

OBJECTIVE: To present the epidemiological profile of cancer patients belonging to a database of a Hospital Cancer Registry and to report on the importance of this database in managing healthcare services at an Oncology and Hematology Center. METHODS: A retrospective survey conducted with 1617 records of patients diagnosed with cancer at the institution between 2004 and 2009. The types of cancer analyzed were of the colon and rectum, breast, prostate and lung. The variables used in the study were age, gender, stage of disease upon diagnosis and treatment. Researchers used an application called SisHCR for data collection, and Excel® for data analysis. To ensure data safety and reliability, passwords were required for accessing files, spreadsheets were backed up on a weekly basis, and patients' CPF numbers were used to avoid data duplication. RESULTS: Of the 1617 records analyzed, 36.42% belonged to the topographic group of the breast, and approximately 40% of patients with colorectal cancer were 70 years of age or older. Stage II was prevalent, representing 44% of the sample, and the treatment most used was surgery (57% of cases). CONCLUSION: The study suggested that the Hospital Cancer Registry database is an instrument capable of generating important information about cancer, and that through this information, epidemiological studies can be carried out and the processes of management and care can be improved.