Healthcare costs among patients with hematologic malignancies receiving allogeneic transplants: a US payer perspective

Abstract

Patients with hematologic malignancies undergoing allogeneic hematopoietic cell transplant (allo-HCT) require extensive care. Using the Merative® MarketScan® Commercial Claims and Encounters Database (2016 Q1-2020 Q2), we quantified the costs of care and assessed real-world complication rates among commercially-insured US patients diagnosed with a hematologic malignancy and aged 12-64 years undergoing inpatient allo-HCT. Healthcare resource use and costs were assessed from 100 days pre-HCT to 100 days post-HCT. Primary hospitalization was defined as the time from HCT until first discharge date. Incidence of complications was assessed using medical billing codes from HCT date to 100 days post-HCT. Among the 1082 patients analyzed, allo-HCT grafts included peripheral blood (79%), bone marrow (11%), and umbilical cord blood (3%). In the 100 days post-HCT, 52% experienced acute graft-versus-host disease; 21% had cytomegalovirus infection. The median primary hospitalization length of stay (LOS) was 28 days; 31% required readmission in first 100 days post-HCT. Across the transplant period (14 days pretransplant to 100 days posttransplant), 44% of patients were admitted to the intensive care unit with a median LOS of 29 days. Among those in noncapitated health plans (n = 937), median all-cause healthcare per-patient cost during the transplant period was $331,827, which was driven by primary hospitalization and readmission. Additionally, the predicted median incremental costs per additional day in an inpatient setting increased with longer LOS (e.g., $3381 to $4071 from 10th to 20th day.) Thus, decreasing length of primary hospitalization and avoiding readmissions should significantly reduce allo-HCT cost of care.