Costs of care associated with high-dose therapy and autologous transplantation for non-Hodgkin's lymphoma: results from the University of Nebraska Medical Center 1989 to 1995

The purpose of this paper was to (1) comprehensively analyze transplant-rel ated costs for predicted temporal cost shifting and (2) to evaluate whether previous findings of decreasing costs of care persisted using a cost analy sis of 353 NHL patients who received autologous stem cell transplantation ( SCT) at the University of Nebraska Medical Center. All transplant-related c osts between the patient's initial consult and program dismissal were obtai ned and inflated to constant 1995 dollars. Homogeneous resources were categ orized into six cost-drivers and subdivided into outpatient, transplant, an d additional inpatient time periods in order to evaluate resource utilizati on and cost shifting patterns. Between 1989 and 1991 both the average lengt h of stay and comprehensive costs decreased 4.9 days and 14%, respectively. By 1995 additional decreases of 25.7 days and 51% led to an overall 7 year cost decline of 65%. Percent contributions of the six cost-drivers remaine d similar demonstrating uniformed suppression in transplant-related resourc e consumption. In contrast, the timing of resource utilization changed dram atically, with transplant hospitalization costs accounting for 83% of the o verall costs in 1989, 71% by 1992, and only 45% in 1995, while total outpat ient's contribution was 14%, 26% and 49%. Before 1991 ebbing costs were lik ely related to the development of new technologies such as hematopoietic gr owth factors and peripheral SCT, while the three-fold larger improvement in costs reported by 1995 are presumably associated with learning curve effec ts such as organizational changes, increased use of coordinated outpatient facilities, and the more cost-effective use of laboratory tests and pharmac euticals.