The costs and cost-effectiveness of allogeneic peripheral blood stem cell transplantation versus bone marrow transplantation in pediatric patients with acute leukemia

Yu Feng Lin, David R. Lairson, Wenyaw Chan, Xianglin L. Du, Kathryn S. Leung, Alana A. Kennedy-Nasser, Caridad A. Martinez, Stephen M. Gottschalk, Catherine M. Bollard, Helen E. Heslop, Malcolm K. Brenner, Robert A. Krance

Research output: Contribution to journalArticle

30 Scopus citations

Abstract

In a retrospective study, we evaluated the cost and cost-effectiveness of allogeneic peripheral blood stem cell transplantation (PBSCT) (n = 30) compared with bone marrow transplantation (BMT) (n = 110) in children with acute leukemia after 1 year of follow-up. Treatment success was defined as disease-free survival at 1 year posttransplantation. For patients at standard risk for disease, the treatment success rate was 57.1% for PBSCT recipients and 80.3% for BMT recipients (P = not significant [NS]). The average total cost per treatment success at 1 year in the standard-risk disease group was $512,294 for PBSCT recipients and $352,885 for BMT recipients (P = NS). For patients with high-risk disease, the treatment success rate was 18.8% for PBSCT recipients and 23.5% for BMT recipients (P = NS). The cumulative average cost was $457,078 in BMT recipients and $377,316 in PBSCT recipients (P = NS). Point estimates of the incremental cost-effectiveness ratio (ICER) indicate that in patients with standard-risk disease, allogeneic BMT had lower costs and greater effectiveness than PBSCT (ICER, -$687,108; 95% confidence interval [CI], $2.4 million to dominated). For patients with high-risk disease, BMT was more effective and more costly, and it had an ICER of $1.69 million (95% CI, $29.7 million to dominated) per additional treatment success. The comparative economic evaluation provides support for BMT in standard-risk patients, but much uncertainty precludes a clear advantage of either treatment option in patients with high-risk disease. More studies using larger and randomized controlled trials are needed to confirm the long-term cost-effectiveness of each procedure.

Original languageEnglish (US)
Pages (from-to)1272-1281
Number of pages10
JournalBiology of Blood and Marrow Transplantation
Volume16
Issue number9
DOIs
StatePublished - Sep 2010

Keywords

  • Children
  • Long-term follow-up
  • Treatment success

ASJC Scopus subject areas

  • Transplantation
  • Hematology

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