The Costs and Cost-Effectiveness of Unrelated Donor Bone Marrow Transplantation for Chronic Phase Chronic Myelogenous Leukemia

Unrelated donor transplantation prolongs survival in some patientswith chronic myelogenous leukemia (CML) in chronic phase. However,there are growing concerns about the intensive resources required forthis procedure given health care budget constraints. To address thisissue, we conducted a study of the costs and cost-effectiveness ofunrelated donor transplantation for chronic phase CML. The costs oftransplantation were derived from 157 patients from the Brigham andWomen's Hospital (BWH) and the Fred Hutchinson Cancer Research Center(FHCRC). Estimates of the effectiveness of transplantation were takenfrom our previous work using data from the International Bone MarrowTransplant Registry and the National Marrow Donor Program.The median cost of the first 6 months of care including donoridentification, marrow collection, patient hospitalization fortransplantation and all outpatient medications and readmissions through6 months postmarrow infusion was $178,500 (range, $85,000 to $462,400)and the mean was $196,200. Mean costs for patients surviving beyond 6 months posttransplant were significantly lower than for patients dyingwithin that period ($189,700 v $211,000, respectively,P = .03). Posttransplant follow-up costs were high formonths 6 to 18, then decreased. The incremental cost-effectiveness oftransplantation within 1 year of diagnosis versus -interferon therapy without transplant in the base case of a 35-year-old patient was $51,800/quality-adjusted life year (QALY) gained. Sensitivity analysis showed that most ratios were between $50,000 to $100,000/QALY or within the intermediate zone of acceptable cost-effectiveness ratios.