COSTS OF CARE AND OUTCOMES FOR HIGH-DOSE THERAPY AND AUTOLOGOUS TRANSPLANTATION FOR LYMPHOID MALIGNANCIES - RESULTS FROM THE UNIVERSITY-OF-NEBRASKA 1987 THROUGH 1991

Purpose and Methods: High-dose therapy with autologous stem-cell suppo rt has become common treatment for relapsed or refractory lymphomas. W e conducted a study of 178 patients with Hodgkin's disease and 149 pat ients with non-Hodgkin's lymphoma who received high-dose therapy with stem-cell support. We evaluated the following: (1) whether improvement s in outcomes over time found for surgical procedures were also true f or a new nonsurgical procedure, autologous bone marrow and peripheral stem-cell transplantation; and (2) whether such a relationship, if it existed, applied to both clinical and economic outcomes. Results: Mort ality rates for patients with Hodgkin's disease decreased from 20% in 1987 to 0% in 1991. For non-Hodgkin's lymphoma, the mortality rate dec reased from 29% in 1987 to 4% in 1991. Multivariate analyses indicated that the number of previous transplants was the most important factor associated with survival and low-cost care. After controlling for dif ferences in clinical factors, a logistic regression model predicted th at patients with Hodgkin's disease had a 20% chance of dying after 30 cases and a 5% chance after 178 cases; patients with non-Hodgkin's dis ease had a 33% chance of dying after 14 cases and a 5% chance after 14 9 cases. For patients with Hodgkin's disease, the cost decreased at a rate of 10% per year from 1987 to 1991 (P = .001), while for patients with non-Hodgkin's lymphoma, the cost of transplants decreased at a ra te of 8% per year. Conclusion: Survival rates improved and costs of ca re decreased over time for patients who received high-dose therapy wit h stem-cell support. These changes are most likely related to improvem ents in supportive care technologies, better patient selection, and ex perience of the transplant team. J Clin Oncol 13:969-973. (C) 1995 by American Society of Clinical Oncology.