Introduction Allogeneic hematopoietic stem cell transplantation (alloHSCT) is a complex procedure that involves significant clinical challenges and substantial healthcare resource utilization. However, it does not always achieve the desired outcomes.

This study aims to quantify the costs associated with alloHSCT and to assess the quality of life (QoL) of long-term survivors. Additionally, it analyzes factors that may influence these outcomes.

Methodology A retrospective observational study was conducted on patients aged ≥18, residing in our region, who underwent alloHSCT between 2016 and 2019.

Costs incurred during the first-year post-alloHSCT were analyzed up to the point of relapse or death, whichever occurred first. A microcosting approach was employed, categorizing costs into four areas: pre-transplant assessment (including evaluation of the patient and, if applicable, the related donor, as well as procurement of hematopoietic progenitors); hospitalization for the alloHSCT procedure; subsequent hospitalizations; and outpatient follow-up. The analysis included direct healthcare costs, such as hospital admissions, outpatient consultations, emergency visits, complementary tests, pharmaceutical expenses, and transfusion support.

Additionally, the EQ-5D-3L, FACT-BMT, and WPAI:GH questionnaires were administered to patients at their final follow-up within the study period.

Results A total of 71 patients were analyzed, 38 (54%) were male, and the median age was 57 years (range 18-78). Donor types included HLA-matched sibling donor (MSD) in 20 cases (28%), haploidentical related donor in 22 cases (31%), HLA-matched unrelated donor (MUD) in 27 cases (38%), and mismatched unrelated donor in 2 cases (3%). Bone marrow was the source of hematopoietic progenitors in 43 patients (61%), and peripheral blood in 28 (39%).

During the first year of follow-up, 10 patients (14%) experienced relapse and 17 (24%) died, with 6 of these deaths occurring after relapse. No hospitalizations were required post-alloHSCT in 36 patients (51%), and the median number of re-admissions was 1 (range 0-7). Acute graft-versus-host disease (aGvHD) ocurred in 32 patients (45%), while chronic graft-versus-host disease (cGvHD) was observed in 30 patients (42%).

The average cost per patient for the entire procedure was €83,894. The largest cost component was the initial hospitalization for alloHSCT (€53,563), followed by post-discharge follow-up (€24,250) and pre-transplant assessment (€6,081).

AlloHSCT from MUD was significantly more costly than from MSD (€95,687 vs. €68,953, p=0.034), with no significant differences observed among other donor types. Additionally, alloHSCT was more expensive in patients who required more than 1 re-admission (€131,479 vs. €71,148, p=0.005). Sex, age (<65 years vs. ≥65 years), source of hematopoietic progenitors, and the development of GvHD did not significantly impact the cost of first-year alloHSCT.

QoL questionnaires were completed by 40 patients, with a median age of 54.5 years (range 24-68) and a median follow-up of 7.3 years post-alloHSCT. At the time of last follow-up, all patients were in remission, and 17 had active cGvHD.

The median EQ-5D index was 0.914 (range 0.576-1), the median EQ VAS score was 90% (range 20%-100%), and the median FACT-BMT score was 116.7 (range 55-145). A good correlation was observed between the EQ-5D-3L and FACT-BMT questionnaires (Spearman's Rho correlation >0.6). Patients with active cGvHD at the time of assessment had significantly lower EQ VAS scores (70% vs. 80%, p=0.022).

At the time of questionnaire completion, 11 patients were engaged in work activities, representing 44% of the 25 patients of working age (≤65 years). According to the WPAI:GH questionnaire, the impact on productivity was significantly worse in patients with active cGvHD (3 vs. 0, p=0.012).

Conclusions AlloHSCT involves substantial healthcare costs, with transplants from MUD and cases requiring multiple re-admissions significantly increasing overall expenses. However, in our cohort, factors such as age, sex, source of hematopoietic progenitors, and, surprisingly, the development of GvHD did not significantly impact first-year costs.

Long-term survivors generally report good QoL, although active cGvHD is associated with poorer health perception and decreased productivity.

These results highlight the importance of optimizing resource allocation and post-transplant care to improve both cost-effectiveness and patient outcomes.

This content is only available as a PDF.
2025
Sign in via your Institution