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The lifelong health care cost of a patient with sickle cell disease (SCD) is estimated at ~$1 million (Kauf, AJH 2009). Allogeneic stem cell transplantation (alloSCT) remains the only curative option for SCD, but no data exists investigating health care utilization related to alloSCT. We hypothesize that alloSCT in children with SCD reduces health care utilization in comparison to children with SCD who do not receive alloSCT.
Financial data from 2002-2011 was analyzed across the two groups. The health care utilization was determined over three time periods: pre-alloSCT, during alloSCT (day 0 to day +365), and post-alloSCT. The control group consisted of patients referred for alloSCT and/or HLA typed without alloSCT. Subjects without inpatient or outpatient visits during the study time periods were included in the analysis with a value of 0. The number of inpatient/outpatient visits was compared with Poisson regression method, and health care cost was compared with un-paired t-test.
The alloSCT and control cohorts included 26 patients (mean age - 6.78yrs), and 47 patients (mean age - 5.15yrs), respectively. The 3-yr EFS for patients receiving HLA matched sibling alloSCT was 100% and 44.4% for unrelated cord blood transplant recipients. The mean total cost per patient during the alloSCT year was $414,000 inpatient and $28,000 outpatient. The average monthly inpatient visits were similar in pre and post-alloSCT time periods; while the number of inpatient visits in the post-alloSCT period was significantly lower than the control group (0.03 ±0.10 vs. 0.13±0.13/month, p=0.0003). The average number of outpatient visits was also significantly lower post-alloSCT compared to pre-alloSCT (1.08±1.05 vs. 3.84±4.33/month, p<0.0001). When compared to controls, the post-alloSCT cohort had significantly higher outpatient visits (1.08 ±1.05 vs. 0.26±0.29/month, p<0.0001). Detailed health care utilization is described in the table below.
This analysis indicates that post-alloSCT health care utilization decreases when compared to pre-alloSCT. However, this does not translate into decreased cost when compared to controls. This may reflect the limitation of the study period to identify the actual changes in utilization over time. More detailed analysis is ongoing to determine variables contributing to the substantial alloSCT associated costs and the long term change in costs over time.
| Cases (monthly) | Controls (monthly) | p-value | |
Pre-AlloSCT {A} (n=26,mean(SD) | Post- AlloSCT {B} (n=20, mean(SD) | Controls {C} n=47,mean(SD) | ||
Inpatient visit | 0.10 (0.15) | 0.03 (0.10) | 0.13 (0.13) | A vs. B 0.306 B vs. C 0.0003 |
Inpatient Cost($) | 4713.2 (10895.2) | 2433.3 (9970.4) | 2307.3 (5825.4) | A vs. B 0.303 B vs. C 0.958 |
Outpatients visits | 3.84 (4.33) | 1.08 (1.05) | 0.26 (0.29) | A vs. B <0.0001 B vs. C <0.0001 |
Outpatient Cost ($) | 3045.8 (4222.4) | 9514.9 (32163.8) | 5577.7 (15392.4) | A vs. B 0.295 B vs. C 0.606 |