Costs of pediatric allogeneic hematopoietic-cell transplantation

Allogeneic hematopoietic-cell transplantation (HCT), although curative for some high-risk diseases, is a complex and costly procedure. The costs of transplantation among children have not been described previously.

We compared the costs of HCT within the first 100-days among children who received myeloablative HCT from either a matched related donor (MRD, N = 27), matched unrelated donor (MUD, N = 28) or unrelated umbilical cord blood (UCB, N = 91). We also conducted analyses to describe predictors of higher costs of transplantation.

The 100-day probabilities of overall survival were 96%, 96% and 87% for MRD, MUD and UCB, respectively. The mean cost per day survived (excluding costs of graft acquisition) was $3,446 (standard deviation (SD), $851) for MRD, $4,050 (SD, $1,194) for MUD and $4,522 (SD, $2,053) for UCB recipients. The costs of MUD and UCB HCT remained similar when costs of graft acquisition were considered within total costs of transplantation. In multivariable analysis, adjusting for important patient, disease, and transplant related characteristics, factors associated with higher costs within the first 100-days were HCT using MUD or UCB, Lansky score <90 at transplant, graft failure, need for dialysis, need for mechanical ventilation and occurrence of hepatic veno-occlusive disease.

Within the first 100-days, the costs of MUD and UCB HCT are similar, while MRD HCT is less costly. These costs are primarily driven by severe post-transplant complications and graft failure.