Economics and Outcome After Hematopoietic Stem Cell Transplantation: A Retrospective Cohort Study

TY - JOUR

T1 - Economics and Outcome After Hematopoietic Stem Cell Transplantation: A Retrospective Cohort Study

AU - Gratwohl, Alois

AU - Sureda, Anna

AU - Baldomero, Helen

AU - Gratwohl, Michael

AU - Dreger, Peter

AU - Kröger, Nicolaus

AU - Ljungman, Per

AU - McGrath, Eoin

AU - Mohty, Mohamad

AU - Nagler, Arnon

AU - Rambaldi, Alessandro

AU - de Elvira, Carmen Ruiz

AU - Snowden, John A

AU - Passweg, Jakob

AU - Apperley, Jane

AU - Niederwieser, Dietger

AU - Stijnen, Theo

AU - Brand, Ronald

AU - Joint Accreditation Committee (JACIE) of the International Society for Cellular Therapy (ISCT) and the European Society for Blood and Marrow Transplantation (EBMT) and the European Leukemia Net (ELN)

PY - 2015/12

Y1 - 2015/12

N2 - Hematopoietic stem cell transplantation (HSCT) is a lifesaving expensive medical procedure. Hence, more transplants are performed in more affluent countries. The impact of economic factors on patient outcome is less defined. We analyzed retrospectively a defined cohort of 102,549 patients treated with an allogeneic (N = 37,542; 37%) or autologous (N = 65,007; 63%) HSCT. They were transplanted by one of 404 HSCT centers in 25 European countries between 1999 and 2006. We searched for associations between center-specific microeconomic or country-specific macroeconomic factors and outcome. Center patient-volume and center program-duration were significantly and systematically associated with improved survival after allogeneic HSCT (HR 0·87; 0·84-0·91 per 10 patients; p < 0·0001; HR 0·90;0·85-0·90 per 10 years; p < 0·001) and autologous HSCT (HR 0·91;0·87-0·96 per 10 patients; p < 0·001; HR 0·93;0·87-0·99 per 10 years; p = 0·02). The product of Health Care Expenditures by Gross National Income/capita was significantly associated in multivariate analysis with all endpoints (R(2) = 18%; for relapse free survival) after allogeneic HSCT. Data indicate that country- and center-specific economic factors are associated with distinct, significant, systematic, and clinically relevant effects on survival after HSCT. They impact on center expertise in long-term disease and complication management. It is likely that these findings apply to other forms of complex treatments.

AB - Hematopoietic stem cell transplantation (HSCT) is a lifesaving expensive medical procedure. Hence, more transplants are performed in more affluent countries. The impact of economic factors on patient outcome is less defined. We analyzed retrospectively a defined cohort of 102,549 patients treated with an allogeneic (N = 37,542; 37%) or autologous (N = 65,007; 63%) HSCT. They were transplanted by one of 404 HSCT centers in 25 European countries between 1999 and 2006. We searched for associations between center-specific microeconomic or country-specific macroeconomic factors and outcome. Center patient-volume and center program-duration were significantly and systematically associated with improved survival after allogeneic HSCT (HR 0·87; 0·84-0·91 per 10 patients; p < 0·0001; HR 0·90;0·85-0·90 per 10 years; p < 0·001) and autologous HSCT (HR 0·91;0·87-0·96 per 10 patients; p < 0·001; HR 0·93;0·87-0·99 per 10 years; p = 0·02). The product of Health Care Expenditures by Gross National Income/capita was significantly associated in multivariate analysis with all endpoints (R(2) = 18%; for relapse free survival) after allogeneic HSCT. Data indicate that country- and center-specific economic factors are associated with distinct, significant, systematic, and clinically relevant effects on survival after HSCT. They impact on center expertise in long-term disease and complication management. It is likely that these findings apply to other forms of complex treatments.

U2 - 10.1016/j.ebiom.2015.11.021

DO - 10.1016/j.ebiom.2015.11.021

M3 - SCORING: Journal article

C2 - 26844291

VL - 2

SP - 2101

EP - 2109

JO - EBIOMEDICINE

JF - EBIOMEDICINE

SN - 2352-3964

IS - 12

ER -