The costs and cost-effectiveness of unrelated donor bone marrow transplantation for chronic phase chronic myelogenous leukemia
The costs and cost-effectiveness of unrelated donor bone marrow transplantation for chronic phase chronic myelogenous leukemia
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DOI：
10.1182/blood.v92.11.4047.423a04_4047_4052
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发表时间：
1998-12-01
期刊：
影响因子：
20.3
通讯作者：
Weeks, JC
中科院分区：
文献类型：
--
作者：
Lee, SJ;Anasetti, C;Weeks, JC
非亲属供体移植可延长慢性粒细胞白血病（CML）慢性期患者的生存期。然而，由于卫生保健预算的限制，人们越来越关注这一程序所需的大量资源。为了解决这个问题，我们对非亲属供体移植治疗慢性粒细胞白血病的成本和成本效益进行了研究。移植费用来自布里格姆妇女医院（BWH）和弗雷德哈钦森癌症研究中心（FHCRC）的157名患者。移植有效性的估计来自我们之前的工作，使用的数据来自国际骨髓移植登记处和国家骨髓捐赠计划。前6个月的护理费用中位数为178,500美元（范围为85,000美元至462,400美元），包括供体识别，骨髓采集，患者住院接受移植和所有门诊药物治疗以及6个月骨髓输注后的再入院费用为196,200美元。移植后存活超过6个月的患者的平均费用显著低于在此期间死亡的患者（分别为189,700美元和211,000美元，P = 0.03）。移植后随访费用在6 - 18个月期间较高，随后下降。在一名35岁患者的基本病例中，诊断后1年内进行移植与不进行移植的cr-干扰素治疗的增量成本效益为51800美元/质量调整生命年（QALY）。敏感性分析显示，大多数比率在50 000美元至100 000美元/质量aly之间，或在可接受的成本效益比率的中间区域内。(C) 1998年由美国血液病学会出版。
Unrelated donor transplantation prolongs survival in some patients with chronic myelogenous leukemia (CML) in chronic phase. However, there are growing concerns about the intensive resources required for this procedure given health care budget constraints. To address this issue, we conducted a study of the costs and cost-effectiveness of unrelated donor transplantation for chronic phase CML. The costs of transplantation were derived from 157 patients from the Brigham and Women's Hospital (BWH) and the Fred Hutchinson Cancer Research Center (FHCRC). Estimates of the effectiveness of transplantation were taken from our previous work using data from the International Bone Marrow Transplant Registry and the National Marrow Donor Program. The median cost of the first 6 months of care including donor identification, marrow collection, patient hospitalization for transplantation and all outpatient medications and readmissions through 6 months postmarrow infusion was $178,500 (range, $85,000 to $462,400) and the mean was $196,200. Mean costs for patients surviving beyond 6 months posttransplant were significantly lower than for patients dying within that period ($189,700 v $211,000, respectively, P = .03). Posttransplant follow-up costs were high for months 6 to 18, then decreased. The incremental cost-effectiveness of transplantation within 1 year of diagnosis versus cr-interferon therapy without transplant in the base case of a 35-year-old patient was $51,800/quality-adjusted life year (QALY) gained. Sensitivity analysis showed that most ratios were between $50,000 to $100,000/QALY or within the intermediate zone of acceptable cost-effectiveness ratios. (C) 1998 by The American Society of Hematology.