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.
Truven Health Analytics, Cambridge, Massachusetts.
Biol Blood Marrow Transplant. 2017 Oct;23(10):1788-1794. doi: 10.1016/j.bbmt.2017.06.017. Epub 2017 Jul 5.
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.
在美国，每年大约进行 20000 次造血细胞移植（HCT）手术。有关移植后并发症相关成本的真实世界数据有限。在 2011 年 1 月 1 日至 2014 年 6 月 30 日期间，从 Truven Health MarketScan 研究数据库中确定了年龄≥18 岁、接受自体造血细胞移植（auto-HCT）或异基因造血细胞移植（allo-HCT）的血液系统恶性肿瘤患者。要求患者在 HCT 前后有 12 个月的连续医疗和药房入组；还包括 HCT 后 12 个月内住院死亡的患者。排除有既往 HCT 史的患者。如果在 HCT 后 1 年内有医疗索赔记录显示疾病复发、感染、心血管、肾脏、神经、肺、肝或胃肠道疾病、继发性恶性肿瘤、血栓性微血管病或可逆性后部脑病综合征的诊断代码，则认为存在潜在的与 HCT 相关的并发症。通过比较有并发症的 HCT 受者和无并发症的 HCT 受者的总费用，评估这些并发症导致的医疗保健费用。进一步将 MarketScan 研究数据库与社会保障管理局的主死亡文件链接，以在部分患者中获得患者死亡事件。共有 2672 名 HCT 受者纳入分析。受者的平均年龄±标准差为 54.5±11.6 岁，大多数受者（63.6%）接受 auto-HCT。81%的 auto-HCT 受者和 95.5%的 allo-HCT 受者发生了并发症。大多数并发症发生在 HCT 后 180 天内。与无并发症的 auto-HCT 受者相比，有并发症的受者调整后的总费用高出 51475 美元（P<0.01）。与无并发症的 allo-HCT 受者相比，有并发症的受者调整后的总费用高出 181473 美元（P<0.01）。在有死亡率数据的患者中，有并发症的 auto-HCT 受者的死亡率（13.4%比 5.7%，P<0.01）更高，生存率（P<0.01）更低。然而，allo-HCT 受者中，有并发症与无并发症的受者之间的死亡率和生存率无显著差异。在商业保险人群中，有并发症的 HCT 受者在直接医疗保健费用方面存在相当大的经济负担，在自体 HCT 中，有并发症的受者死亡率更高。
