Department of Pediatrics, Columbia University Medical Center, New York, NY, USA.
Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Department of Pediatrics, Columbia University Medical Center, New York, NY, USA.
Bone Marrow Transplant. 2019 May;54(5):691-699. doi: 10.1038/s41409-018-0308-0. Epub 2018 Aug 20.
The costs associated with allogeneic hematopoietic cell transplantation (alloHCT) are high. Differences in costs and healthcare utilization among potential donor sources for alloHCT are not well characterized in pediatric recipients of alloHCT. One potential reason for these high costs could be the donor source of hematopoietic cells. In this retrospective study, inpatient costs, outpatient costs, and markers of healthcare utilization associated with unrelated donor alloHCT for malignant and non-malignant disease were analyzed for 131 pediatric patients during the first year post-transplant, for whom the donor sources were 38% umbilical cord blood (UCB), 14% unmanipulated peripheral blood stem cell (PBSC), 26% bone marrow (BM), and 22% PBSC with CD-34 selection. The median cost per day survived (through day +365) was lowest for patients receiving PBSC with CD-34 selection $926 (322-5316) as compared to UCB $1918 (491-107,93), unmanipulated PBSC $1516 (630-27,516), and BM $1205 (506-11,181) (p = 0.010). For non-malignant alloHCT, UCB had the highest costs per day survived $1530 (491-793) and PBSC with CD-34 selection had the lowest at $482 (322-3092) (p < 0.001). In a multivariable model for costs per day survived, high-risk disease (p = 0.009) and graft failure (p < 0.001) were significantly associated with higher cost and alloHCT between 2010 and 2015 as compared to 2005 and 2009 (p = 0.017) was significantly associated with lower cost per day survived. This study illustrates important differences in cost and healthcare utilization among the different donor sources used for unrelated alloHCT.
异基因造血细胞移植（alloHCT）相关成本很高。在接受 alloHCT 的儿科患者中，异基因供体来源之间的成本和医疗保健利用差异尚未得到很好的描述。造成这些高成本的一个潜在原因可能是造血细胞的供体来源。在这项回顾性研究中，分析了 131 名接受恶性和非恶性疾病的无关供体 alloHCT 的儿科患者在移植后第一年的住院费用、门诊费用和与医疗保健利用相关的标志物，其供体来源分别为 38%的脐带血（UCB）、14%未经处理的外周血干细胞（PBSC）、26%的骨髓（BM）和 22%的经 CD-34 选择的 PBSC。接受 CD-34 选择的 PBSC 的患者每天的中位存活成本（通过第 365 天）最低，为 926 美元（322-5316 美元），而 UCB 为 1918 美元（491-10793 美元）、未经处理的 PBSC 为 1516 美元（630-27516 美元）和 BM 为 1205 美元（506-11181 美元）（p=0.010）。对于非恶性 alloHCT，UCB 的每天存活成本最高，为 1530 美元（491-793 美元），而 CD-34 选择的 PBSC 最低，为 482 美元（322-3092 美元）（p<0.001）。在生存成本的多变量模型中，高危疾病（p=0.009）和移植物失败（p<0.001）与较高的成本显著相关，与 2005 年至 2009 年相比，2010 年至 2015 年 alloHCT（p=0.017）与较低的每日生存成本显著相关。本研究说明了在无关 alloHCT 中使用不同供体来源的成本和医疗保健利用之间的重要差异。
