Outpatient-based bone marrow transplantation for hematologic malignancies:Cost saving or cost shifting?

Purpose: To determine whether a shift in care from an inpatient-based to an outpatient-based bone marrow transplantation (BMT) program decreased charg es to payers without increasing clinical complications or out-of-pocket cos ts to patients. Patients and Methods: This nonrandomized prospective cohort study compared clinical and economic outcomes for 132 consecutive BMT patients with hemato logic malignancies who received either inpatient- or outpatient-based BMT c are. Results: Seventeen of 132 BMT patients underwent outpatient-based BMT. Comp ared with the inpatient-based group, the outpatient-based group had a marke dly lower mean number of inpatient hospital days (22 v 47; P < .001) and de creased mean inpatient facility charges ($61,059 less per patient: P < .000 1) but had higher mean outpatient facility charges ($49,732 higher; P < .00 01), Total professional fees were similar for the groups, The mean total ch arge Co payers was only 7% less ($12,652; P = .21) for outpatient-based BMT than for inpatient-based BMT, but total charge was 34% less for outpatient compared with inpatient BMT ($54,240; P = 0.056) in a subset of patients w ho had a standard rather than high risk of treatment failure. There was no significant difference between groups in out-of-pocket costs for transporta tion, lodging, meals, home nursing, household assistance, child care, medic ation expenses, or unreimbursed medical bills. There also was no significan t difference between groups in reported income lost, involuntary unemployme nt; or months of disability. The two groups herd similar rates of major com plications, including death, significant acute graft-versus-host disease, a nd veno-occlusive disease of the liver. Conclusion: Increased use of outpatient-based BMT should produce substantia l cost savings for payers without adverse effects on patients for those pat ients who do not have a high risk of treatment failure.