A model for analysing the cost of autologous peripheral blood progenitor cell (PBPC) transplantation

Data from autologous peripheral blood progenitor cell (PBPC) transplant rec ipients were used for cost analysis and modelling so as to link the main in tervention procedures and clinical events to resource use and costs, This c ohort consisted of 64 patients from 4 to 62 years old at transplantation (m ean, 36.9 years) who underwent a first transplant between August 1994 and M ay 1997, The main indications for transplantation were non-Hodgkin's lympho mas (47%), multiple myeloma (30%) and Hodgkin's lymphomas (15%), The course of a patient during the whole transplant procedure was modelled using a Ma rkov chain of six states of health: (I) mobilisation and recovery of PBPC; (2) post-mobilisation phase; (3) conditioning and transplant; (4) critical haematological reconstitution; (5) noncritical haematological reconstitutio n; (6) death. The probability of transition between the different health st ates, together with the estimated costs, were the input for the Markov mode l. The model also managed transition probabilities depending both on the cu rrent health state and on various demographic, clinical and procedure-relat ed covariates unique to the patient, The expected time spent in each clinic al state and the expected total cost were, therefore, estimated. This analy sis gave an actual total cost per transplanted patient of $26 600 (95 % ran ge: $24 700 to $43 500) while mean duration was 197 days. The expenses for in-hospital stay accounted for 80% of the costs. Both the probability of st aying in the different states, and the consequent cost were dependent on th e number of CD34-positive cells collected, the phase and the type of the di sease, the subset of patients (either children or adults), and the post-tra nsplant G-CSF prophylaxis. The sensitivity of the estimates to alternative assumptions was studied, and the method of comparing alternative future sce narios by the model was explored.