Reducing costs without compromising quality in the pediatric allogeneic transplantation setting

Blood and marrow transplantation (BMT) is a costly procedure. In 1998, we began to institute practices aimed at reducing costs without compromising quality and outcomes. These changes in our practice were introduced sequentially over a 4-year period. Several cost reducing strategies were used, including eliminating weekly chest radiographs, limiting laboratory tests, replacing total parenteral nutrition with enteral tube feedings (in 2001), addition of glutamine (in 1999), and replacing intravenous tacrolimus with oral tacrolimus for graft-versus-host disease (GVHD) prevention. The outcomes of 78 consecutive allogeneic BMTs performed between 1995 and 2004 were analyzed. Parameters for analysis included GVHD, day 100 survival, overall survival, engraftment, relapse-free survival, days in the pediatric intensive care unit, bacteremia, veno-occlusive disease of the liver, and transplantation-related mortality. There was no significant difference in any outcome parameter when each of the practice changes was analyzed separately or even when taken together. This suggests that institutional supportive care practices should be periodically reviewed for their value, effect on patient care, burden to nursing staff, and discomfort to the patient. Future studies analyzing time and cost savings by point-of-care practitioners should focus on those intensive practices that are not based on sound medical evidence.