5-year health care burden after allogeneic hematopoietic stem cell transplantation (HSCT): Impact of graft source

ASH: 60th American Society of Hematology Annual Meeting & ExpositionJG Garcia, S Grillo, Q Cao, CG Brunstein, M Arora, ML MacMillan, JE Wagner, DJ Weisdorf, SG Holtan | December 02, 2018

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Summary: With this study, researchers assessed and estimated the 5-year health care burden after allogeneic hematopoietic stem cell transplantation (HSCT). They concluded that patients receiving umbilical cord blood (UCB) transplant seem to experience a lower long-term health care burden compared with other graft sources. After the first year post-HSCT, recipients of UCB transplant have fewer clinic visits, laboratory tests, procedures, and medications. Researchers also added that despite the absence of cost data and details of care outside of their location, their data support the hypothesis that health care burden varies by graft source with favorable outcomes in long-term survivors after UCB transplant compared recipients of bone marrow (BM) and peripheral blood stem cells (PBSC).

Methods:

  • Researchers analyzed clinical data from 1,077 consecutive allogeneic HSCT recipients (median age: 52.2 years; 41.4% women) at the University of Minnesota Medical Center (UMMC) who had been transplanted between 2000-2016.
  • To determine changes in health care burden over time, they studied the raw number of visits (both face-to-face and non-face-to-face care coordination visits), procedures, laboratory studies, medications, and relative value units (RVUs) over 3 time periods:
    • Day 0 to day 100,
    • 101–365 days, and
    •  > 1 year–5 years after HSCT.
  • They also assessed the counts of these health care elements individually and as a composite score (visits, procedures, labs, medications, RVUs), and compared the estimated health care burden by graft source over each time period.
  • Only patients undergoing their first allogeneic HSCT were included, with all clinical data from transplant to death or 5 years, whichever came first.

Results:

  • In all, 102 patients received BM, 458 received PBSC, and 517 received UCB (84.7% double).
  • Most BM donors were matched but unrelated to the recipient (57%), and most PBSC donors were matched siblings (88%).
  • The median distance from the patients’ address to the transplant center was < 30 miles, with no significant difference between the graft sources at any of the three time periods (P=0.12, P=0.10, P=0.09, respectively).
  • A total of 40.8% of patients had acute myeloid leukemia, 13.7% acute lymphoblastic leukemia, 13% non-Hodgkin's lymphoma, and 12.8% myelodysplastic syndrome.
  • Researchers found no significant difference in the proportions of patients who died (P=0.50) or had relapse/progression (P=0.22) between graft sources over these time periods.
  • As expected from previous data, PBSC recipients had the lowest median composite health care burden in the first 100 days (P < 0.01).
  • During this earliest time period, the following median levels were significantly lower in PBSC recipients compared with BM and UCB, respectively:
    • laboratory studies (2,213 vs 2,448.0 vs 2,960; P < 0.01),
    • medications (132 vs 232 vs 203; P < 0.01), and
    • RVUs billed (423.2 vs 480.7 vs 466.7; P < 0.01).
  • Researchers found no difference in the number of visits (P=0.07).
  • From days 101–365, UCB had the lowest composite score (P=0.02), with the fewest labs and visits performed (P < 0.01 for each); and researchers found no difference between the graft sources during this time in medications (P=0.16) or RVUs (P=0.06).
  • Beyond 1 year, they found that UCB continued to have the lowest composite score (P=0.02), with the lowest number of visits (P< 0.01), labs (P < 0.01), procedures (P=0.03), medications (P < 0.01), and RVUs (P=0.02) compared with BM and PBSC.

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