Department of Internal Medicine, Division of Hematology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
Eur J Haematol. 2022 Apr;108(4):327-335. doi: 10.1111/ejh.13740. Epub 2022 Jan 13.
Allogeneic haematopoietic stem cell transplantation (HSCT) is increasingly used, but this treatment is complex and costly. As clinical outcomes of HSCT with matched unrelated donor (MUD) and haploidentical donors are similar, costs could influence donor choice.
We retrospectively compared resource utilisation and costs of HSCT using the three different donor types (matched related donor (MRD) (n = 32), haploidentical related (n = 30) and MUD (n = 60)) within the first year after transplantation. Costs were analysed through a bottom-up method. Non-parametric bootstrapping was applied to test for statistical differences in costs. Subgroup analyses were performed to identify predictors for costs.
Cost pre-transplant for search and acquisition of the graft were significantly higher in MUD HSCT (€35 222) versus MRD and haploidentical HSCT (€15 356 and €16 097 respectively). The costs of haploidentical HSCT were the highest in the transplant phase. Main cost factors were inpatient days and medication. Overall, the costs for haploidentical and MUD HSCT were similar (€115 724 for MUD, €113 312 for haploidentical).
Our study suggests no difference in total transplantation costs between allogeneic HSCT using a MUD or a haploidentical donor. Since clinical outcomes seem similar as well, the choice of donor type might be based on availability, speed and logistics.
异基因造血干细胞移植（HSCT）的应用日益增多，但这种治疗方法复杂且费用高昂。由于亲缘半相合供者（haploidentical related）和无关供者（MUD）HSCT 的临床结果相似，费用可能会影响供者的选择。
我们通过回顾性分析，比较了三种不同供者类型（匹配相关供者（MRD）（n=32）、亲缘半相合相关供者（n=30）和 MUD（n=60））在移植后第一年的资源利用和成本。成本分析采用自下而上的方法。非参数 bootstrap 法用于检验成本的统计学差异。进行亚组分析以确定成本的预测因素。
MUD HSCT（€35222）在移植前寻找和获取移植物的成本明显高于 MRD 和 haploidentical HSCT（€15356 和 €16097）。haploidentical HSCT 的移植阶段成本最高。主要成本因素是住院天数和药物。总体而言，haploidentical 和 MUD HSCT 的成本相似（MUD 为 €115724，haploidentical 为 €113312）。
我们的研究表明，使用 MUD 或 haploidentical 供者进行异基因 HSCT 的总移植成本没有差异。由于临床结果似乎也相似，因此供者类型的选择可能基于可用性、速度和物流。
