Clinical risks and healthcare utilization of hematopoietic cell transplantation for sickle cell disease in the USA using merged databases

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Clinical risks and healthcare utilization of hematopoietic cell transplantation for sickle cell disease in the USA using merged databases

Arnold, Staci D. (författare): Emory Univ Hosp, 1364 Clifton Rd NE, Atlanta, GA 30322 USA.

Brazauskas, Ruta (författare): Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA.;Med Coll Wisconsin, Inst Hlth & Soc, Div Biostat, Milwaukee, WI 53226 USA.

He, Naya (författare): Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA.

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Li, Yimei (författare): Univ Penn, Philadelphia, PA 19104 USA.

Aplenc, Richard (författare): Univ Penn, Philadelphia, PA 19104 USA.

Jin, Zhezhen (författare): Columbia Univ, Mailman Sch Publ Hlth, Dept Biostat, New York, NY USA.

Hall, Matt (författare): Columbia Univ, Med Ctr, Dept Pediat, Div Pediat Hematol Oncol & Stem Cell Transplantat, New York, NY USA.

Atsuta, Yoshiko (författare): Japanese Data Ctr Hematopoiet Cell Transplantat, Nagoya, Aichi, Japan.;Nagoya Univ, Grad Sch Med, Nagoya, Aichi, Japan.

Dalal, Jignesh (författare): Rainbow Babies & Childrens Hosp, 2101 Adelbert Rd, Cleveland, OH 44106 USA.

Hahn, Theresa (författare): Roswell Pk Canc Inst, Dept Med, Buffalo, NY 14263 USA.

Khera, Nandita (författare): Mayo Clin, Dept Hematol Oncol, Phoenix, AZ USA.

Bonfim, Carmem (författare): Univ Fed Parana, Hosp Clin, Curitiba, Parana, Brazil.

Majhail, Navneet S. (författare): Cleveland Clin, Taussig Canc Inst, Blood & Marrow Transplant Program, Cleveland, OH 44106 USA.

Diaz, Miguel Angel (författare): Hosp Infantil Univ Nino Jesus, Dept Hematol Oncol, Madrid, Spain.

Freytes, Cesar O. (författare): Texas Transplant Inst, San Antonio, TX USA.

Wood, William A. (författare): Univ N Carolina, Dept Med, Div Hematol Oncol, Chapel Hill, NC USA.

Savani, Bipin N. (författare): Vanderbilt Univ, Med Ctr, Dept Med, Div Hematol Oncol, Nashville, TN USA.

Kamble, Rammurti T. (författare): Baylor Coll Med, Ctr Cell & Gene Therapy, Div Hematol & Oncol, Houston, TX 77030 USA.

Parsons, Susan (författare): Tufts Med Ctr, Boston, MA USA.

Ahmed, Ibrahim (författare): Rainbow Babies & Childrens Hosp, 2101 Adelbert Rd, Cleveland, OH 44106 USA.

Sullivan, Keith (författare): Duke Univ, Med Ctr, Durham, NC USA.

Beattie, Sara (författare): Univ Ottawa, Ottawa, ON, Canada.

Dandoy, Christopher (författare): Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH 45229 USA.

Munker, Reinhold (författare): Louisiana State Univ Hlth Shreveport, Dept Internal Med, Sect Hematol Oncol, Shreveport, LA USA.

Marino, Susana (författare): Univ Chicago Hosp, Chicago, IL 60637 USA.

Bitan, Menachem (författare): Tel Aviv Sourasky Med Ctr, Dept Pediat Hematol Oncol, Tel Aviv, Israel.

Abdel-Azim, Hisham (författare): Univ Southern Calif, Keck Sch Med, Childrens Hosp Los Angeles, Div Hematol Oncol & Blood & Marrow Transplantat, Los Angeles, CA 90033 USA.

Aljurf, Mahmoud (författare): King Faisal Specialist Hosp Ctr & Res, Dept Oncol, Riydah, Saudi Arabia.

Olsson, Richard F. (författare): Karolinska Institutet,Uppsala universitet,Centrum för klinisk forskning i Sörmland (CKFD),Karolinska Inst, Dept Lab Med, Div Therapeut Immunol, Stockholm, Sweden

Joshi, Sarita (författare): Nationwide Childrens Hosp, Pediat Hematol Oncol & BMT, Columbus, OH USA.;Ohio State Univ Wexner, Columbus, OH USA.

Buchbinder, Dave (författare): Childrens Hosp Orange Cty, Div Pediat Hematol, Orange, CA 92668 USA.

Eckrich, Michael J. (författare): Levine Childrens Hosp, Charlotte, NC USA.

Hashmi, Shahrukh (författare): Mayo Clin, Dept Internal Med, Minneapolis, MN USA.

Lazarus, Hillard (författare): Univ Hosp Case Med Ctr, Seidman Canc Ctr, Cleveland, OH USA.

Marks, David I. (författare): Univ Hosp Bristol NHS Trust, Adult Bone Marrow Transplant, Bristol, Avon, England.

Steinberg, Amir (författare): Mt Saini Hosp, Dept Hematol Oncol, New York, NY USA.

Saad, Ayman (författare): Univ Alabama Birmingham, Dept Med, Div Hematol Oncol, Birmingham, AL USA.

Gergis, Usama (författare): New York Presbyterian Hosp, Weill Cornell Med Coll, Dept Med Oncol, Hematol Malignancies & Bone Marrow Transplant, New York, NY USA.

Krishnamurti, Lakshmanan (författare): Emory Univ Hosp, 1364 Clifton Rd NE, Atlanta, GA 30322 USA.

Abraham, Allistair (författare): Childrens Natl Med Ctr, Ctr Canc & Blood Disorders, Div Blood & Marrow Transplantat, Washington, DC 20010 USA.

Rangarajan, Hemalatha G. (författare): Nationwide Childrens Hosp, Pediat Hematol Oncol & BMT, Columbus, OH USA.;Ohio State Univ Wexner, Columbus, OH USA.

Walters, Mark (författare): Childrens Hosp & Res Ctr Oakland, Oakland, NY USA.

Lipscomb, Joseph (författare): Emory Univ, Winship Canc Inst, Rollins Sch Publ Hlth, Hlth Policy & Management, Atlanta, GA 30322 USA.

Saber, Wael (författare): Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA.

Satwani, Prakash (författare): Columbia Univ, Med Ctr, Dept Pediat, Div Pediat Hematol Oncol & Stem Cell Transplantat, New York, NY USA.

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Emory Univ Hosp, 1364 Clifton Rd NE, Atlanta, GA 30322 USA Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA.;Med Coll Wisconsin, Inst Hlth & Soc, Div Biostat, Milwaukee, WI 53226 USA. (creator_code:org_t)

2017-08-17
2017
Engelska.
Ingår i: Haematologica. - : Ferrata Storti Foundation (Haematologica). - 0390-6078 .- 1592-8721. ; 102:11, s. 1823-1832

Relaterad länk:: https://doi.org/10.3...; visa fler...; https://uu.diva-port... (primary) (Raw object); https://doi.org/10.3...; https://urn.kb.se/re...; https://doi.org/10.3...; http://kipublication...; visa färre...

Tidskriftsartikel (refereegranskat)

Abstract Ämnesord

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Advances in allogeneic hematopoietic cell transplantation for sickle cell disease have improved outcomes, but there is limited analysis of healthcare utilization in this setting. We hypothesized that, compared to late transplantation, early transplantation (at age < 10 years) improves outcomes and decreases healthcare utilization. We performed a retrospective study of children transplanted for sickle cell disease in the USA during 2000-2013 using two large databases. Univariate and Cox models were used to estimate associations of demographics, sickle cell disease severity, and transplant-related variables with mortality and chronic graft-versus-host disease, while Wilcoxon, Kruskal-Wallis, or linear trend tests were applied for the estimates of healthcare utilization. Among 161 patients with a 2-year overall survival rate of 90% (95% confidence interval [CI] 85-95%) mortality was significantly higher in those who underwent late transplantation versus early (hazard ratio (HR) 21, 95% CI 2.8-160.8, P=0.003) and unrelated compared to matched sibling donor transplantation (HR 5.9, 95% CI 1.7-20.2, P=0.005). Chronic graftversus host disease was significantly more frequent among those translanted late (HR 1.9, 95% CI 1.0-3.5, P=0.034) and those who received an unrelated graft (HR 2.5, 95% CI 1.2-5.4; P=0.017). Merged data for 176 patients showed that the median total adjusted transplant cost per patient was $467,747 (range: $344,029-$ 799,219). Healthcare utilization was lower among recipients of matched sibling donor grafts and those with low severity disease compared to those with other types of donor and disease severity types (P<0.001 and P=0.022, respectively); no association was demonstrated with late transplantation (P=0.775). Among patients with 2-year pre-and post-transplant data (n=41), early transplantation was associated with significant reductions in admissions (P<0.001), length of stay (P<0.001), and cost (P=0.008). Early transplant outcomes need to be studied prospectively in young children without severe disease and an available matched sibling to provide conclusive evidence for the superiority of this approach. Reduced post-transplant healthcare utilization inpatient care indicates that transplantation may provide a sustained decrease in healthcare costs over time.

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Av författaren/redakt...: Arnold, Staci D.; Brazauskas, Ruta; He, Naya; Li, Yimei; Aplenc, Richard; Jin, Zhezhen; visa fler...; Hall, Matt; Atsuta, Yoshiko; Dalal, Jignesh; Hahn, Theresa; Khera, Nandita; Bonfim, Carmem; Majhail, Navneet ...; Diaz, Miguel Ang ...; Freytes, Cesar O ...; Wood, William A.; Savani, Bipin N.; Kamble, Rammurti ...; Parsons, Susan; Ahmed, Ibrahim; Sullivan, Keith; Beattie, Sara; Dandoy, Christop ...; Munker, Reinhold; Marino, Susana; Bitan, Menachem; Abdel-Azim, Hish ...; Aljurf, Mahmoud; Olsson, Richard ...; Joshi, Sarita; Buchbinder, Dave; Eckrich, Michael ...; Hashmi, Shahrukh; Lazarus, Hillard; Marks, David I.; Steinberg, Amir; Saad, Ayman; Gergis, Usama; Krishnamurti, La ...; Abraham, Allista ...; Rangarajan, Hema ...; Walters, Mark; Lipscomb, Joseph; Saber, Wael; Satwani, Prakash; visa färre...

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MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Hematologi

Artiklar i publikationen: Haematologica

Av lärosätet: Uppsala universitet; Karolinska Institutet

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Clinical risks and healthcare utilization of hematopoietic cell transplantation for sickle cell disease in the USA using merged databases

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