Cost-Effectiveness of Unrelated Umbilical Cord Blood Transplantation versus HLA-Haploidentical Related Bone Marrow Transplantation: Evidence from BMT CTN 1101.

Autor: Ramsey SD; Fred Hutchinson Cancer Center, Seattle, Washington; CHOICE Institute, Department of Pharmacy, University of Washington, Seattle, Washington. Electronic address: sramsey@fredhutch.org., Bansal A; Fred Hutchinson Cancer Center, Seattle, Washington; CHOICE Institute, Department of Pharmacy, University of Washington, Seattle, Washington., Li L; Fred Hutchinson Cancer Center, Seattle, Washington., O'Donnell PV; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts., Fuchs EJ; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland., Brunstein CG; Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota., Eapen M; Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin., Thao V; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota; OptumLabs, Edina, Minnesota., Roth JA; CHOICE Institute, Department of Pharmacy, University of Washington, Seattle, Washington; Pfizer, New York, New York., Steuten LMG; Office of Health Economics, London, United Kingdom.
Jazyk: angličtina
Zdroj: Transplantation and cellular therapy [Transplant Cell Ther] 2023 Jul; Vol. 29 (7), pp. 464.e1-464.e8. Date of Electronic Publication: 2023 Apr 27.
DOI: 10.1016/j.jtct.2023.04.017
Abstrakt: BMT CTN 1101 was a Phase III randomized controlled trial comparing reduced-intensity conditioning followed by double unrelated umbilical cord blood transplantation (UCBT) versus HLA-haploidentical related donor bone marrow transplantation (haplo-BMT) for patients with high-risk hematologic malignancies. Here we report the results of a parallel cost-effectiveness analysis of these 2 hematopoietic stem cell transplantation (HCT) techniques. In this study, 368 patients were randomized to unrelated UCBT (n = 186) or haplo-BMT (n = 182). We estimated healthcare utilization and costs using propensity score-matched haplo-BMT recipients from the OptumLabs Data Warehouse for trial participants age <65 years and Medicare claims for participants age ≥65 years. Weibull models were used to estimate 20-year survival. EQ-5D surveys by trial participants were used to estimate quality-adjusted life-years (QALYs). At a 5-year follow-up, survival was 42% for haplo-BMT recipients versus 36% for UCBT recipients (P = .06). Over a 20-year time horizon, haplo-BMT is expected to be more effective (+.63 QALY) and more costly (+$118,953) for persons age <65 years. For those age ≥65 years, haplo-BMT is expected to be more effective and less costly. In one-way uncertainty analyses, for persons age <65, the cost per QALY result was most sensitive to life-years and health state utilities, whereas for those age ≥65, life- years were more influential than costs and health state utilities. Compared to UCBT, haplo-BMT was moderately more cost-effective for patients age <65 years and less costly and more effective for persons age ≥65 years. Haplo-BMT is a fair value choice for commercially insured patients with high-risk leukemia and lymphoma who require HCT. For Medicare enrollees, haplo-BMT is a preferred choice when considering costs and outcomes.
(Copyright © 2023 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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