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Clinical risks and ...
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Arnold, Staci D.Emory Univ Hosp, 1364 Clifton Rd NE, Atlanta, GA 30322 USA.
(author)
Clinical risks and healthcare utilization of hematopoietic cell transplantation for sickle cell disease in the USA using merged databases
- Article/chapterEnglish2017
Publisher, publication year, extent ...
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2017-08-17
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Ferrata Storti Foundation (Haematologica),2017
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electronicrdacarrier
Numbers
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LIBRIS-ID:oai:DiVA.org:uu-341360
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https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-341360URI
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https://doi.org/10.3324/haematol.2017.169581DOI
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http://kipublications.ki.se/Default.aspx?queryparsed=id:136924520URI
Supplementary language notes
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Language:English
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Summary in:English
Part of subdatabase
Classification
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Subject category:ref swepub-contenttype
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Subject category:art swepub-publicationtype
Notes
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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.
Subject headings and genre
Added entries (persons, corporate bodies, meetings, titles ...)
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Brazauskas, RutaMed Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA.;Med Coll Wisconsin, Inst Hlth & Soc, Div Biostat, Milwaukee, WI 53226 USA.
(author)
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He, NayaMed Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA.
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Li, YimeiUniv Penn, Philadelphia, PA 19104 USA.
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Aplenc, RichardUniv Penn, Philadelphia, PA 19104 USA.
(author)
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Jin, ZhezhenColumbia Univ, Mailman Sch Publ Hlth, Dept Biostat, New York, NY USA.
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Hall, MattColumbia Univ, Med Ctr, Dept Pediat, Div Pediat Hematol Oncol & Stem Cell Transplantat, New York, NY USA.
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Atsuta, YoshikoJapanese Data Ctr Hematopoiet Cell Transplantat, Nagoya, Aichi, Japan.;Nagoya Univ, Grad Sch Med, Nagoya, Aichi, Japan.
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Dalal, JigneshRainbow Babies & Childrens Hosp, 2101 Adelbert Rd, Cleveland, OH 44106 USA.
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Hahn, TheresaRoswell Pk Canc Inst, Dept Med, Buffalo, NY 14263 USA.
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Khera, NanditaMayo Clin, Dept Hematol Oncol, Phoenix, AZ USA.
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Bonfim, CarmemUniv Fed Parana, Hosp Clin, Curitiba, Parana, Brazil.
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Majhail, Navneet S.Cleveland Clin, Taussig Canc Inst, Blood & Marrow Transplant Program, Cleveland, OH 44106 USA.
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Diaz, Miguel AngelHosp Infantil Univ Nino Jesus, Dept Hematol Oncol, Madrid, Spain.
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Freytes, Cesar O.Texas Transplant Inst, San Antonio, TX USA.
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Wood, William A.Univ N Carolina, Dept Med, Div Hematol Oncol, Chapel Hill, NC USA.
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Savani, Bipin N.Vanderbilt Univ, Med Ctr, Dept Med, Div Hematol Oncol, Nashville, TN USA.
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Kamble, Rammurti T.Baylor Coll Med, Ctr Cell & Gene Therapy, Div Hematol & Oncol, Houston, TX 77030 USA.
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Parsons, SusanTufts Med Ctr, Boston, MA USA.
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Ahmed, IbrahimRainbow Babies & Childrens Hosp, 2101 Adelbert Rd, Cleveland, OH 44106 USA.
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Sullivan, KeithDuke Univ, Med Ctr, Durham, NC USA.
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Beattie, SaraUniv Ottawa, Ottawa, ON, Canada.
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Dandoy, ChristopherCincinnati Childrens Hosp Med Ctr, Cincinnati, OH 45229 USA.
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Munker, ReinholdLouisiana State Univ Hlth Shreveport, Dept Internal Med, Sect Hematol Oncol, Shreveport, LA USA.
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Marino, SusanaUniv Chicago Hosp, Chicago, IL 60637 USA.
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Bitan, MenachemTel Aviv Sourasky Med Ctr, Dept Pediat Hematol Oncol, Tel Aviv, Israel.
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Abdel-Azim, HishamUniv Southern Calif, Keck Sch Med, Childrens Hosp Los Angeles, Div Hematol Oncol & Blood & Marrow Transplantat, Los Angeles, CA 90033 USA.
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Aljurf, MahmoudKing Faisal Specialist Hosp Ctr & Res, Dept Oncol, Riydah, Saudi Arabia.
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Olsson, Richard F.Karolinska Institutet,Uppsala universitet,Centrum för klinisk forskning i Sörmland (CKFD),Karolinska Inst, Dept Lab Med, Div Therapeut Immunol, Stockholm, Sweden(Swepub:uu)riols677
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Joshi, SaritaNationwide Childrens Hosp, Pediat Hematol Oncol & BMT, Columbus, OH USA.;Ohio State Univ Wexner, Columbus, OH USA.
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Buchbinder, DaveChildrens Hosp Orange Cty, Div Pediat Hematol, Orange, CA 92668 USA.
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Eckrich, Michael J.Levine Childrens Hosp, Charlotte, NC USA.
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Hashmi, ShahrukhMayo Clin, Dept Internal Med, Minneapolis, MN USA.
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Lazarus, HillardUniv Hosp Case Med Ctr, Seidman Canc Ctr, Cleveland, OH USA.
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Marks, David I.Univ Hosp Bristol NHS Trust, Adult Bone Marrow Transplant, Bristol, Avon, England.
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Steinberg, AmirMt Saini Hosp, Dept Hematol Oncol, New York, NY USA.
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Saad, AymanUniv Alabama Birmingham, Dept Med, Div Hematol Oncol, Birmingham, AL USA.
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Gergis, UsamaNew York Presbyterian Hosp, Weill Cornell Med Coll, Dept Med Oncol, Hematol Malignancies & Bone Marrow Transplant, New York, NY USA.
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Krishnamurti, LakshmananEmory Univ Hosp, 1364 Clifton Rd NE, Atlanta, GA 30322 USA.
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Abraham, AllistairChildrens Natl Med Ctr, Ctr Canc & Blood Disorders, Div Blood & Marrow Transplantat, Washington, DC 20010 USA.
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Rangarajan, Hemalatha G.Nationwide Childrens Hosp, Pediat Hematol Oncol & BMT, Columbus, OH USA.;Ohio State Univ Wexner, Columbus, OH USA.
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Walters, MarkChildrens Hosp & Res Ctr Oakland, Oakland, NY USA.
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Lipscomb, JosephEmory Univ, Winship Canc Inst, Rollins Sch Publ Hlth, Hlth Policy & Management, Atlanta, GA 30322 USA.
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Saber, WaelMed Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA.
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Satwani, PrakashColumbia Univ, Med Ctr, Dept Pediat, Div Pediat Hematol Oncol & Stem Cell Transplantat, New York, NY USA.
(author)
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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)
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In:Haematologica: Ferrata Storti Foundation (Haematologica)102:11, s. 1823-18320390-60781592-8721
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- By the author/editor
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Arnold, Staci D.
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Brazauskas, Ruta
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He, Naya
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Li, Yimei
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Aplenc, Richard
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Jin, Zhezhen
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Hall, Matt
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Atsuta, Yoshiko
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Dalal, Jignesh
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Hahn, Theresa
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Khera, Nandita
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Bonfim, Carmem
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Majhail, Navneet ...
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Diaz, Miguel Ang ...
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Freytes, Cesar O ...
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Wood, William A.
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Savani, Bipin N.
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Kamble, Rammurti ...
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Parsons, Susan
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Ahmed, Ibrahim
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Sullivan, Keith
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Beattie, Sara
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Dandoy, Christop ...
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Munker, Reinhold
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Marino, Susana
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Bitan, Menachem
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Abdel-Azim, Hish ...
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Aljurf, Mahmoud
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Olsson, Richard ...
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Joshi, Sarita
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Buchbinder, Dave
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Eckrich, Michael ...
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Hashmi, Shahrukh
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Lazarus, Hillard
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Marks, David I.
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Steinberg, Amir
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Saad, Ayman
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Gergis, Usama
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Krishnamurti, La ...
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Abraham, Allista ...
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Rangarajan, Hema ...
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Walters, Mark
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Lipscomb, Joseph
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Saber, Wael
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Satwani, Prakash
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Hematology
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Haematologica
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Uppsala University
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Karolinska Institutet