Cost Analysis for Adult Patients with Acute Myeloid Leukemia and Myelodysplastic Syndrome Undergoing Allogeneic Hematopoietic Cell Transplantation

Introduction Hematopoietic cell transplantation (HCT) is a medical procedure indicated for several malignant and non-malignant diseases. Few studies have been published about costs in HCT, despite its fundamentais role in increasing efficiency in resource allocation by transplantation programs. Thus, economic evaluation studies in the transplant setting are extremely important to help better conduct the procedure worldwide. Objective To analyze the cost of HCT performed in adult patients (≥18 years) with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) as their underlying disease. Methods This is a single-center, retrospective cohort study that included adult patients with AML or MDS, who received their first allogeneic HCT between 2010 and 2021. Cost data were extracted from the hospital system. The hospital's standard cost table was used for the cost calculations and the values in Brazilian Reais (R$) were converted into dollars at the exchange rate of R$4.90 (June 10th, 2022). To estimate the median cost, a parametric survival method with lognormal distribution was used. Costs were calculated from HCT admission to 1 year after transplantation and patients who died or were lost to follow-up before 1 year were censored. The statistical software used was R, version 4.1.0. Results The study included 117 patients; median age was 61 years; there was a male predominance, 61% (71) and 70% (82) of the underlying disease was AML. There were 54 (46%) UD, 34 (29%) MSD, and 29 (25%) haploidentical transplants. The median cost of HCT in the matched patients was US$123,598 (intercept). The median cost of Haplo was 2.88 times higher than MSD, US$355,963, (p=0.0001). For UD HLA 9 × 10 and 10 × 10, compared with MSD, costs were 2.84 times greater, US$351,019, (p=0.01) and 1.72 times greater, US$212,589, (p=0.02), respectively. For each 10 years of age increase, the cost increased 1.27 times (p=0.0003). Conclusion We concluded that HCT MSD had a lower cost when compared to other subtypes such as Haplo and UD. Haploidentical and unrelated transplants use a more immunosuppressive platform, with a higher incidence of infections. In addition, there is a higher incidence of non-infectious complications from both HLA incompatibility (haploidentical) and non-HLA incompatibility (unrelated donor). Prospective studies separating the cost by type (like blood bank support and medications) are needed.