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Cost-Effectiveness of Autologous Hematopoietic Stem Cell Transplantation for Elderly Patients with Multiple Myeloma using the Surveillance, Epidemiology, and End Results-Medicare Database. Biol Blood Marrow Transplant 2015 Oct;21(10):1823-9



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In the past decade, the number of autologous hematopoietic stem cell transplants (Auto HSCT) for older patients with multiple myeloma (MM) has increased dramatically, as has the cost of transplantation. The cost-effectiveness of this modality in patients over age 65 is unclear. Using the Surveillance, Epidemiology, and End Results-Medicare database to create a propensity-score matched sample of patients over age 65 between 2000 and 2007, we compared the survival and cost for those who received Auto HSCT to those who did not undergo transplantation but survived at least 6 months after diagnosis, and we calculated an incremental cost-effectiveness ratio (ICER). Two hundred seventy patients underwent transplantation. Median overall survival from diagnosis in those who underwent transplantation was significantly longer than in patients who did not (58 months versus 37 months, P < .001). For patients living longer than 2 years, the median monthly cost during the first year was significantly different, but the middle and last year of life costs were similar. The median cost of the first 100 days after transplantation was $60,000 (range, $37,000 to $85,000). The resultant ICER was $72,852 per life-year gained. Survival after transplantation was comparable to that in those who underwent transplantation patients under 65 years and significantly longer than older patients who did not undergo transplantation. With an ICER less than $100,000/life-year gained, Auto HSCT is cost-effective when compared with nontransplantation care in the era of novel agents and should be considered, where clinically indicated, for patients over the age of 65.

Author List

Shah GL, Winn AN, Lin PJ, Klein A, Sprague KA, Smith HP, Buchsbaum R, Cohen JT, Miller KB, Comenzo R, Parsons SK


Aaron Winn PhD Assistant Professor in the School of Pharmacy Administration department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Age Factors
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols
Combined Modality Therapy
Cost-Benefit Analysis
Databases, Factual
Health Care Costs
Hematopoietic Stem Cell Transplantation
Kaplan-Meier Estimate
Multiple Myeloma
Quality-Adjusted Life Years
SEER Program
Transplantation, Autologous
Treatment Outcome
United States
jenkins-FCD Prod-482 91ad8a360b6da540234915ea01ff80e38bfdb40a