Cost Implications of Comorbidity for Autologous Stem Cell Transplantation in Elderly Patients with Multiple Myeloma Using SEER-Medicare

• Published in: Bone Marrow Research Vol. 2016; pp. 21 - 26
• Main Authors: Shah, Gunjan L., Winn, Aaron, Lin, Pei-Jung, Klein, Andreas, Sprague, Kellie A., Smith, Hedy P., Buchsbaum, Rachel, Cohen, Joshua T., Miller, Kenneth B., Comenzo, Raymond, Parsons, Susan K.
• Format: Journal Article
• Language: English
• Published: Egypt Hindawi Limiteds 01-01-2016; Hindawi Publishing Corporation; John Wiley & Sons, Inc; Hindawi Limited
• Subjects: Age; Cancer; Care and treatment; Classification; Comorbidity; Costs; Demographic aspects; Demographics; Economic aspects; Health care policy; Medical prognosis; Medicare; Multiple myeloma; Patients; Stem cells; Studies; Transplantation; Transplants & implants; United States; California; Georgia
• ISSN: 2090-2999; 2090-3006
• DOI: 10.1155/2016/3645623

Comorbidity is more common in older patients and can increase the cost of care by increasing toxicity. Using the SEER-Medicare database from 2000 to 2007, we examined the costs and life-year benefit of Auto-HSCT for MM patients over the age of 65 by evaluating the difference over time relative to comorbidity burden. One hundred ten patients had an Auto-HSCT in the early time period (2000–2003) and 160 in the late time period (2004–2007). Patients were divided by a Charlson Comorbidity Index (CCI) of 0 or greater than 1 (CCI1+). Median overall survival was 53.5 months for the late time period patients compared to 40.3 months for the early time period patients ( p = 0.031 ). Median costs for CCI0 versus CCI1+ in the early period were, respectively, $70,900 versus $72,000 (100 d); $86,100 versus $98,300 (1 yr); and $139,200 versus $195,300 (3 yrs). Median costs for late period were, respectively, $58,400 versus $60,400 (100 d); $86,300 versus $77,700 (1 yr); and $124,400 versus $110,900 (3 yrs). Comorbidity had a significant impact on survival and cost among early time period patients but not among late time period patients. Therefore, older patients with some comorbidities can be considered for Auto-HSCT depending on clinical circumstances.