Abstract

Objectives: Autologous stem cell transplant (ASCT) includes costly pre-transplant care which must be considered in the overall cost of treatment. The objective of this study was to evaluate total costs of an ASTC, from mobilization/apheresis through 100 days following transplant, in U.S. managed care plans.

Methods: Patients 18+ years of age with evidence of an ASCT between January 1, 2000 and December 31, 2006 were identified from a nationally-representative database of medical and pharmacy claims from over 90 U.S. managed care health plans. Patients were required to have a claim for apheresis within 60 days prior to the ASCT and have a history of multiple myeloma, non-Hodgkin’s lymphoma, or Hodgkin’s disease. Patients were included in the study only if they were continuously enrolled in one health plan for a minimum of 90 days before to 100 days following the ASCT; patients with evidence of a prior ASCT were excluded. Costs were calculated for 4 phases of ASCT:

  1. Mobilization/Apheresis: 5 days prior to the first G-CSF administration through the last apheresis claim,

  2. Conditioning: 1 day after the last apheresis claim to 1 day prior to ASCT,

  3. Transplant: ASCT through 30 days post-transplant, and

  4. Follow-up: 31 to 100 days following transplant.

Paid claims (payer perspective) were used as a proxy for medical costs and were expressed in 2006 US$, adjusted as necessary using the medical care component of the U.S. Consumer Price Index.

Results: A total of 249 ASCT patients were identified; the mean age was 50 years and 57% were male. Total costs from mobilization to 100 days post-transplant averaged $146,890 per patient (median $134,878). Mobilization and apheresis costs comprised 27% of the total costs (mean $38,803), while conditioning therapy represented 43% of the total costs (mean $63,369). Transplant costs (mean $22,032) and follow-up costs (mean $22,686) each accounted for approximately 15% of the total costs.

Conclusion: ASCTs are costly procedures with mean payer costs of almost $150,000. This study reviewed recent U.S. managed care health plan claims data to determine the component costs of ASCT. Conditioning therapy and mobilization/apheresis were identified as the main cost drivers, comprising 43% and 27% of the total costs, respectively. Delineating these ASCT-related costs is important in evaluating the overall economic burden of ASCT on the healthcare system and in estimating the benefit of new therapies that could provide greater efficiency and reduce cost in these areas.

Total Medical Costs from Mobilization through 100 Days Post-ASCT in ASCT Patients (N=249).

 Mean (SD) % of Total Costs 
Total Costs from Mobilization through 100 Days Post-ASCT $146,890 (87,628) -- 
Mobilization/Apheresis $38,803 (31,060) 26.5% 
Conditioning $63,369 (70,836) 43.1% 
Transplant $22,032 (30,960) 15.0% 
Follow-up $22,686 (38,129) 15.4% 
 Mean (SD) % of Total Costs 
Total Costs from Mobilization through 100 Days Post-ASCT $146,890 (87,628) -- 
Mobilization/Apheresis $38,803 (31,060) 26.5% 
Conditioning $63,369 (70,836) 43.1% 
Transplant $22,032 (30,960) 15.0% 
Follow-up $22,686 (38,129) 15.4% 

Disclosures: Pelletier:Genzyme Corporation: Research Funding. Smith:Genzyme Corporation: Research Funding. Dembek:Genzyme Corporation: Employment.

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