CHICAGOThe first US multicenter cost analyses comparing
autologous peripheral blood stem cell transplant (PBSCT) and
autologous bone marrow transplant (BMT) in breast cancer and
non-Hodgkins lymphoma (NHL) showed a cost advantage for stem
cells in breast cancer, but not NHL. Tammy Stinson, project manager
and analyst for Health Services Research, Northwestern University and
VA Chicago Healthcare System, presented the results at the ASH meeting.
She said that this information could be useful for supporting the
introduction of new technologies and for assisting hospitals and
insurance companies in case rate negotiations. Oncology
services are now more often covered by managed care. Clinically based
cost evaluations are important to assure appropriate
reimbursement, Ms. Stinson said.
The current study looked at 609 patients (260 NHL, 349 breast cancer)
from four academic transplant centers treated between 1994 and 1996
with high-dose chemotherapy and transplant: 60% PBSCT and 40% BMT.
The Autologous Blood and Marrow Transplant Registry (ABMTR) provided
clinical and demographic data on the patients, while the
participating centers provided inpatient and outpatient billing data
for each patient.
Ms. Stinson said that the study investigators, including Charles
Bennett, MD, and Teresa Waters, of Northwestern, have had years of
experience deciphering costs.
The methodology used was a cost-identification analysis. The
researchers calculated direct medical care costs associated with
transplant, including inpatient and outpatient use of facilities up
to 100 days post-transplant. Hospital charges were converted to costs
utilizing department-specific cost-to-charge ratios.
A 3% discount rate and adjustments for inflation based on the
Consumer Price Index were taken into account over the course of the
3-year study. Median values were used to identify significant
differences between the two methods of transplantation.
Sampling of Bills Reviewed
To make sure that all associated costs were included, Ms. Stinson
said she reviewed a sampling of the bills from each site to make sure
that the key transplant procedures were included.
I know what charges are typically there, and we developed
methods to estimate missing charges, she said. For
instance, if a center left off a chemotherapy charge, I would use
ABMTR information to find a treatment profile match and estimate the
costs from there. However, this didnt happen very often.
Physician charges were not included, she said, because it was
often difficult to get this information and determine if it was
correct. Physician charges are commonly not included in
economic analyses of treatments, she said.
The study found that overall, for breast cancer patients, the
median cost of PBSCT was $8,809 lower than the cost of BMT ($58,645
vs $67,454). For NHL patients, the $5,719 difference ($67,999 for
PBSCT vs $73,618 for BMT) favored PBSCT but was not significant.
The main cost drivers for both types of cancers and in both
transplant methods were pharmacy, room, blood bank products and lab
testing. The lack of a cost difference between BMT and PBSCT for NHL
may be due to the high variance in the median values of these cost
drivers, she said.
The non-Hodgkins costs are more variable than breast
cancer costs, Ms. Stinson explained, because for breast
cancer patients whether the transplant therapy is bone marrow or stem
cell, it is often first-line therapy. In NHL patients, it may
be second-, third, or even fourth-line therapy. In this study, 34% of
the NHL patients were transplanted after primary induction failure,
17% in CR, and 47% following relapse.
A New Cost Study
Currently, a new cost study of PBSCT vs BMT is under review with the
National Cancer Institute through the NIH. It will be done in
collaboration with the ABMTR.
Dr. Mary Horowitz, of the International Blood and Marrow Transplant
Registry (IBMTR), Dr. Bennett, Ms. Waters, and Ms. Stinson will be
the chief investigators. Eighteen institutions will be included, and
the researchers hope to accrue 9,000 to 10,000 patients. They also
hope to look at hospital organizational behavior and how it relates