Stem-Cell Transplant in Multiple Myeloma Associated with Increased Healthcare Utilization and Costs

Chase Doyle

July 2018 - Leukemia, Multiple Myeloma


Atlanta, GA—A recent analysis of US administrative claims data showed that stem-cell transplantation (SCT) is associated with increased healthcare resource utilization and costs compared with matched controls. According to data presented at 2017 ASH, patients who underwent SCT had, on average, >$114,000 increase in healthcare costs compared with age-, sex-, and comorbidity-matched patients with multiple myeloma who did not undergo SCT.

This discrepancy in costs was largely driven by hospital admissions, said lead investigator Sikander Ailawadhi, MD, Oncologist, Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL. However, despite the increased economic burden, patients with multiple myeloma who underwent SCT had a higher probability of survival compared with matched controls.

Increased Healthcare Resource Use and Costs

High-dose induction chemotherapy followed by SCT is recommended for eligible patients with newly diagnosed multiple myeloma, but data regarding the impact of SCT on healthcare utilization and costs are limited. In their retrospective cohort study, Dr Ailawadhi and colleagues used US administrative claims data from the MarketScan Commercial and Medicare Supplemental databases to select adults with newly diagnosed multiple myeloma between July 2006 and September 2015. Eligibility criteria include continuous health plan enrollment for 12 months before and ≥3 months after diagnosis.

The per-patient per-year (PPPY) all-cause and multiple myeloma–related healthcare utilization and costs were calculated during follow-up, and were compared between patients who did and did not undergo SCT. Of the 14,229 patients with newly diagnosed multiple myeloma who were selected for the study, 2669 (18.8%) had SCT; of those, 2667 (99.9%) were matched to patients with multiple myeloma who did not undergo transplant. Patients were matched for age, sex, Charlson Comorbidity Index, and baseline comorbidities.

The total all-cause and multiple myeloma–related healthcare costs PPPY were $114,242 and $110,116 higher, respectively, among patients who underwent SCT versus those who did not. When broken down by cost components, patients who had a transplant incurred $55,663 and $49,803 higher all-cause and multiple myeloma–related costs, respectively, for hospitalizations, and $39,852 and $33,883 higher all-cause and multiple myeloma–related costs, respectively, for outpatient services.

Treatment costs, including drug and administration costs, were also $26,430 higher, on average, among patients who underwent SCT versus those who did not. Higher costs among patients who had a transplant were driven by increased healthcare utilization for inpatient and outpatient services across most categories, but hospital admissions represented the largest proportion of costs.

Stem-Cell Transplantation Prolongs Survival

Nevertheless, patients who underwent SCT had a significantly higher probability of survival during follow-up, emphasized Dr Ailawadhi. The median survival time among patients who underwent SCT was 907 days compared with 743 days for patients who did not undergo SCT (P <.001).

Because this study was conducted retrospectively using diagnosis and procedure codes contained on healthcare administrative claims, it is limited by the completeness and accuracy of medical coding.

“An examination of the predictors of management with or without SCT and associated outcomes will inform the relative value of therapeutic strategies for MM [multiple myeloma] patients, as well as help optimally triage healthcare resources,” concluded Dr Ailawadhi and colleagues.