Economics and Outcome After Hematopoietic Stem Cell Transplantation: A Retrospective Cohort Study
Journal
EBioMedicine
ISSN-Digital
2352-3964
Type
journal article
Date Issued
2015-12
Author(s)
Gratwohl, Alois
;
Sureda, Anna
;
Baldomero, Helen
;
Gratwοhl, Μichael
;
Dreger, Peter
;
Kröger, Nicolaus
;
Ljungman, Per
;
McGrath, Eoin
;
Mohty, Mohamad
;
Nagler, Arnon
;
Rambaldi, Alessandro
;
Ruiz de Elvira, Carmen
;
Snowden, John A.
;
Passweg, Jakob
;
Apperley, Jane
;
Niederwieser, Dietger
;
Steijnen, Theo
;
Brand, Ronald
Abstract
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.
Language
English
HSG Classification
contribution to scientific community
Refereed
Yes
Publisher
Elsevier
Publisher place
Amsterdam [u.a.]
Volume
2
Number
12
Start page
2101
End page
2109
Subject(s)
Eprints ID
251382