Association of hematopoietic cell transplantation-specific comorbidity index with resource utilization after
L Decook1, Y-H Chang2, J Slack1
1Department of Hematology/Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA.
Insights
The hematopoietic cell transplantation (HCT)-specific comorbidity index (HCT-CI) is linked to increased resource utilization, including longer hospital stays and fewer days alive out of hospital, after allogeneic HCT. This finding helps identify patients at risk for high healthcare use.
Area of Science:
- Hematology
- Transplantation Medicine
- Health Services Research
Background:
- Comorbidities significantly impact patient outcomes and healthcare costs.
- The hematopoietic cell transplantation (HCT)-specific comorbidity index (HCT-CI) is established for predicting mortality risk post-HCT.
- The relationship between HCT-CI and resource utilization (RU) after HCT remains unclear.
Purpose of the Study:
- To investigate the association between the HCT-CI and resource utilization (RU) in patients undergoing allogeneic HCT.
- To analyze RU metrics including readmissions, length of hospital stay (LOS), and days out of hospital alive (DOHA) within the first 100 days and at 1 year post-HCT.
Main Methods:
- Retrospective analysis of 328 allogeneic HCT patients from January 2010 to June 2014.
- Categorization of patients into four HCT-CI score groups: 0-1, 2, 3, and ⩾4.
- Multivariable analysis to assess the association of HCT-CI with RU metrics.
Main Results:
- Readmissions were higher in the first 100 days for patients with HCT-CI >0-1 (P=0.03), but not significantly different at 1 year (P=0.13).
- Multivariable analysis revealed that patients with HCT-CI >0-1 experienced increased LOS and fewer DOHA at both 100 days and 1 year.
- Significant differences in age, disease risk, conditioning, and antithymocyte globulin use were observed across HCT-CI groups.
Conclusions:
- The HCT-CI score of >0-1 is associated with increased resource utilization after allogeneic HCT.
- Identifying HCT-CI as a predictor of RU can aid in recognizing high-risk patients.
- Understanding RU predictors is crucial for managing healthcare costs and resource allocation in HCT.
Abstract:
Comorbidities affect clinical outcomes and costs in medicine. The hematopoietic cell transplantation (HCT)-specific comorbidity index (HCT-CI) predicts mortality risk after HCT. Its association with resource utilization (RU) is unknown. In this single-center, retrospective study, we examined the association of HCT-CI with RU (readmissions, length of hospital stay (LOS) and days out of hospital alive (DOHA)) in first 100 days (n=328) and 1 year (n=226) in allogeneic HCT patients from January 2010 to June 2014. Age, disease risk, conditioning and use of antithymocyte globulin were significantly different in the four groups with HCT-CI 0 to1 (n=138), 2 (n=56), 3 (n=55) or ⩾4 (n=79). Although the readmissions were higher in the first 100 days for patients with HCT-CI >0-1 (P=0.03), they were not significantly different in patients over 1 year (P=0.13). In the multivariable analysis, patients with HCT-CI score of >0 to 1 had increased LOS and fewer DOHA in both 100 days and 1 year after HCT. In this exploratory analysis, we found that HCT-CI >0 to 1 is associated with increased RU after allogeneic HCT. Recognizing predictors of RU can identify patients at risk of high utilization and help understand what drives health-care costs.
Related Concept Videos
01:22Bone Marrow Sampling and Transplants
The transplant begins with high doses of chemotherapy and radiation treatment, which aim to destroy...
01:25Immunodeficiency Diseases
There are three main causes of immunodeficiency...
01:24Tissue Transplantation
The Biology of Tissue Transplantation
The biology of tissue transplantation hinges on the Major Histocompatibility Complex (MHC) molecules. These molecules...