Predicting the costs of allogeneic sibling stem-cell transplantation:: Results from a prospective, multicenter, French study

Background. Allogeneic hematopoietic stem-cell transplantation is a widely used, cost-intensive procedure. Our purpose was to estimate costs and determine cost predictors. Methods. We used data from a prospective French study comparing four doses of immunoglobulins. Resource use of hematopoietic stem-cell transplant recipients during the first 6 months posttransplant, both inpatient and ambulatory costs, in 85 patients from five centers were collected prospectively and costed. Baseline data and clinical events were retrieved. Protocol-driven costs were excluded. Multivariable analysis evaluated the association between costs and patient's pretransplant status and transplant-related complications. Because of the absence of differences in outcome among the four randomization groups, cost data for all patients were pooled. Results. Total costs per patient were the following: mean E76,237; standard deviation E32,565; median E69,516; range E183,758 to E14,761. The major cost driver was hospital days. No association was found between costs and baseline status. The "predictors" of higher costs (adding an average E20,000/patient) were the occurrence of transplant-related complications: graft-versus-host disease and repeated infections that were unpredictable before transplant in this homogeneous group of patients. Conclusion. Our data highlight the discrepancy between the Diagnosis Related Group prospective payment system and actual costs. The actual cost of genoidentical stem-cell transplantation results from posttransplant complications that cannot be predicted prospectively and require ex post cost adjustment.