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The Impact of Donor Type on Outcomes and Cost of Allogeneic Hematopoietic Cell Transplantation for Pediatric Leukemia: A Merged Center for International Blood and Marrow Transplant Research and Pediatric Health Information System Analysis.
Arnold, Staci D; Brazauskas, Ruta; He, Naya; Li, Yimei; Hall, Matt; Atsuta, Yoshiko; Dalal, Jignesh; Hahn, Theresa; Khera, Nandita; Bonfim, Carmem; Hashmi, Shahrukh; Parsons, Susan; Wood, William A; Steinberg, Amir; Freytes, César O; Dandoy, Christopher E; Marks, David I; Lazarus, Hillard M; Abdel-Azim, Hisham; Bitan, Menachem; Diaz, Miguel Angel; Olsson, Richard F; Gergis, Usama; Seber, Adriana; Wirk, Baldeep; LeMaistre, C Fred; Ustun, Celalettin; Duncan, Christine; Rizzieri, David; Szwajcer, David; Fagioli, Franca; Frangoul, Haydar; Knight, Jennifer M; Kamble, Rammurti T; Mehta, Paulette; Schears, Raquel; Satwani, Prakash; Pulsipher, Michael A; Aplenc, Richard; Saber, Wael.
Afiliação
  • Arnold SD; Aflac Cancer and Blood Disorder Center Children's Healthcare of Atlanta Emory University, Atlanta, Georgia. Electronic address: staci.denise.arnold@emory.edu.
  • Brazauskas R; Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin.
  • He N; Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
  • Li Y; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Hall M; Children's Hospital Association, Mission, Kansas.
  • Atsuta Y; Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan; Department of Biostatistics, Epidemiology, and Informatics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
  • Dalal J; Department of Biostatistics, Epidemiology, and Informatics, Rainbow Babies & Children's Hospital, Cleveland, Ohio.
  • Hahn T; Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York.
  • Khera N; Department of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona.
  • Bonfim C; Department of Biostatistics, Epidemiology, and Informatics, Hospital de Clinicas-Federal University of Parana, Curitiba, Brazil.
  • Hashmi S; Oncology Center, King Faisal Specialist Hospital and Research Center, Riydah, Saudi Arabia; Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
  • Parsons S; Department of Biostatistics, Epidemiology, and Informatics, Tufts Medical Center, Boston, Massachusetts.
  • Wood WA; Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina.
  • Steinberg A; Division of Hematology and Oncology, Mount Saini Hospital, New York, New York.
  • Freytes CO; Texas Transplant Institute, San Antonio, Texas.
  • Dandoy CE; Department of Biostatistics, Epidemiology, and Informatics, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, Ohio.
  • Marks DI; Adult Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, United Kingdom.
  • Lazarus HM; Department of Biostatistics, Epidemiology, and Informatics, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.
  • Abdel-Azim H; Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California.
  • Bitan M; Department of Pediatric Hematology/Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
  • Diaz MA; Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain.
  • Olsson RF; Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden.
  • Gergis U; Department of Medical Oncology, Division of Hematological Malignancies, Thomas Jefferson University, Philadelphia, Pennsylvania.
  • Seber A; Department of Biostatistics, Epidemiology, and Informatics, Hospital Samaritano de São Paulo, São Paulo, Brazil.
  • Wirk B; Bone Marrow Transplant Program, Penn State Cancer Institute, Hershey, Pennsylvania.
  • LeMaistre CF; Sarah Cannon Blood Cancer Network, Nashville, Tennessee.
  • Ustun C; Division of Hematology/Oncology/Cell Therapy, Rush University, Chicago, Illinois.
  • Duncan C; Department of Pediatric Oncology, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts.
  • Rizzieri D; Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, North Carolina.
  • Szwajcer D; Cancer Care Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada.
  • Fagioli F; Pediatric Onco-Hematology, Stem Cell Transplantation and Cell Therapy Division, City of Science and Health of Turin, Regina Margherita Children Hospital, Turin, Italy.
  • Frangoul H; Department of Biostatistics, Epidemiology, and Informatics, The Children's Hospital at TriStar Centennial Medical Center, Nashville, Tennessee; Sarah Cannon Research Institute, Nashville, Tennessee.
  • Knight JM; Department of Psychiatry, Medical College of Wisconsin, Milwaukee, Wisconsin.
  • Kamble RT; Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas.
  • Mehta P; Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; University of Arkansas for Medical Sciences, Little Rock, Arkansas.
  • Schears R; Department of Emergency Medicine, University of Central Florida, Orlando, Florida.
  • Satwani P; Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, Columbia University Medical Center, New York, New York.
  • Pulsipher MA; Section of Transplantation and Cellular Therapy, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California.
  • Aplenc R; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Saber W; Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
Biol Blood Marrow Transplant ; 26(9): 1747-1756, 2020 09.
Article em En | MEDLINE | ID: mdl-32464284
Allogeneic hematopoietic stem cell transplantation (alloHCT) may be associated with significant morbidity and mortality, resulting in increased healthcare utilization (HCU). To date, no multicenter comparative cost analyses have specifically evaluated alloHCT in children with acute leukemia. In this retrospective cohort study, we examined the relationship between survival and HCU while investigating the hypothesis that matched sibling donor (MSD) alloHCT has significantly lower inpatient HCU with unrelated donor (URD) alloHCT, and that among URDs, umbilical cord blood (UCB) alloHCT will have higher initial utilization but lower long-term utilization. Clinical and transplantation outcomes data from the Center for International Blood and Marrow Transplant Research (CIBMTR) were merged with inpatient cost data from the Pediatric Health Information System (PHIS) database using a probabilistic merge methodology. The merged dataset comprised US patients age 1 to 21 years who underwent alloHCT for acute leukemia between 2004 and 2011 with comprehensive CIBMTR data at a PHIS hospital. AlloHCT was analyzed by donor type, with specific analysis of utilization and costs using PHIS claims data. The primary outcomes of overall survival (OS), leukemia-free survival (LFS), and inpatient costs were evaluated using Kaplan-Meier curves and Cox and Poisson models. A total of 632 patients were identified in both the CIBMTR and PHIS data. The 5-year LFS was 60% for MSD alloHCT, 47% for well-matched matched unrelated donor bone marrow (MUD) alloHCT, 48% for mismatched unrelated donor alloHCT, and 45% for UCB alloHCT (P = .09). Total adjusted costs were significantly lower for MSD alloHCT versus MUD alloHCT by day 100 (adjusted cost ratio [ACR], .73; 95% confidence interval [CI], .62 to .86; P < .001), and higher for UCB alloHCT versus MUD alloHCT (ACR, 1.27; 95% CI, 1.11 to 1.45; P < .001). By 2 years, total adjusted costs remained significantly lower for MSD alloHCT compared with MUD alloHCT (ACR, .67; 95% CI, .56 to .81; P < .001) and higher for UCB alloHCT compared with MUD alloHCT (ACR, 1.25; 95% CI, 1.02 to 1.52; P = .0280). Our data show that UCB and MUD alloHCT provide similar survival outcomes; however, MUD alloHCT has a significant advantage in cost by day 100 and 2 years. More research is needed to determine whether the cost difference among URD alloHCT approaches remains significant with a larger sample size and/or beyond 2 years post-alloHCT.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Leucemia Mieloide Aguda / Transplante de Células-Tronco Hematopoéticas / Sistemas de Informação em Saúde Tipo de estudo: Health_economic_evaluation / Observational_studies / Risk_factors_studies Limite: Adolescent / Adult / Child / Child, preschool / Humans / Infant Idioma: En Ano de publicação: 2020 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Leucemia Mieloide Aguda / Transplante de Células-Tronco Hematopoéticas / Sistemas de Informação em Saúde Tipo de estudo: Health_economic_evaluation / Observational_studies / Risk_factors_studies Limite: Adolescent / Adult / Child / Child, preschool / Humans / Infant Idioma: En Ano de publicação: 2020 Tipo de documento: Article