Predicting costs of stem-cell transplantation

Purpose: Few studies have formally evaluated the relationship between costs , baseline patient characteristics, and major complications of stem-cell tr ansplantation. We sought (1) to determine whether obtaining baseline inform ation enabled identification of patients whose treatments would be the most costly and (2) to estimate inpatient costs for managing specific transplan tation complications. Patients and Methods: We collected inpatient costs and clinical information for 236 consecutive patients undergoing transplantation at a single instit ution between July 1, 1994, and February 20, 1997. Multivariable linear reg ression was used to evaluate the associations between baseline patient char acteristics and costs of hospitalization for initial transplantation and be tween clinical events and such costs. Results: The median initial inpatient cost in 1997 dollars was $55,500 for autologous transplantation (range, $28,200 to $148,200) and $105,300 for al logeneic transplantation (range, $32,500 to $338,000), When only baseline v ariables were considered, use of a mismatched allogeneic donor and year of transplantation were significant predictors of costs. No characteristics pr edicted which patients would incur the highest 10% of costs. When clinical events were considered, infection and in-hospital death were associated wit h higher costs in autologous transplant recipients ($18,400 and $20,500, re spectively), whereas infection, veno-occlusive disease, acute graft-versus- host disease, and death were predicted to add between $15,300 and $28,100 e ach to allogeneic transplantation costs. Conclusion: We were not able to identify before transplantation the patient s whose treatments would be the most costly. However, the association betwe en clinical complications and higher costs suggests that prevention may hav e significant economic benefits. Interventions that decrease these complica tions may have favorable cost-benefit ratios even if they do not affect ove rall survival. (C) 2000 by American Society of Clinical Oncology.