Blood, Vol. 92 No. 11 (December 1), 1998:
pp. 4047-4052
The Costs and Cost-Effectiveness of Unrelated Donor Bone Marrow
Transplantation for Chronic Phase Chronic Myelogenous Leukemia
Stephanie J. Lee,
Claudio Anasetti,
Karen M. Kuntz,
Jonathan Patten,
Joseph H. Antin, and
Jane C. Weeks
From the Department of Adult Oncology, Dana-Farber Cancer Institute
and the Department of Medicine, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA; the Department of Health Policy and
Management, Harvard School of Public Health, Boston, MA; and Fred
Hutchinson Cancer Research Center, Seattle, WA.
Unrelated donor transplantation prolongs survival in some patients
with chronic myelogenous leukemia (CML) in chronic phase. However,
there are growing concerns about the intensive resources required for
this procedure given health care budget constraints. To address this
issue, we conducted a study of the costs and cost-effectiveness of
unrelated donor transplantation for chronic phase CML. The costs of
transplantation were derived from 157 patients from the Brigham and
Women's Hospital (BWH) and the Fred Hutchinson Cancer Research Center
(FHCRC). Estimates of the effectiveness of transplantation were taken
from our previous work using data from the International Bone Marrow
Transplant Registry and the National Marrow Donor Program.
The median cost of the first 6 months of care including donor
identification, marrow collection, patient hospitalization for
transplantation and all outpatient medications and readmissions through
6 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 dying
within that period ($189,700 v $211,000, respectively,
P = .03). Posttransplant follow-up costs were high for
months 6 to 18, then decreased. The incremental cost-effectiveness of
transplantation 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.
