Cost-effectiveness analysis of early vs. late autologous stem cell transplantation in multiple myeloma

Authors

  • Chintan Pandya,

    Corresponding author
    1. Department of Public Health Sciences, University of Rochester, Rochester, NY, USA
    • Corresponding author: Chintan Pandya, MD, MPH, Division of Health Policy and Outcomes Research, Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd, PO Box 420644, Rochester, NY 14642-0644, USA.

      Tel.: 631-413-6172; fax: 585-461-4532; e-mail: chintan_pandya@urmc.rochester.edu

    Search for more papers by this author
  • Shahrukh Hashmi,

    1. Transplant Center, Mayo Clinic, Rochester, MN, USA
    2. Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
    Search for more papers by this author
  • Nandita Khera,

    1. Hematology Oncology/Blood and Marrow Transplant, Mayo Clinic Arizona, Phoenix, AZ, USA
    Search for more papers by this author
  • Morie A. Gertz,

    1. Transplant Center, Mayo Clinic, Rochester, MN, USA
    2. Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
    Search for more papers by this author
  • Angela Dispenzieri,

    1. Transplant Center, Mayo Clinic, Rochester, MN, USA
    2. Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
    Search for more papers by this author
  • William Hogan,

    1. Transplant Center, Mayo Clinic, Rochester, MN, USA
    2. Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
    Search for more papers by this author
  • Mustaqeem Siddiqui,

    1. Transplant Center, Mayo Clinic, Rochester, MN, USA
    2. Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
    Search for more papers by this author
  • Katia Noyes,

    1. Surgical Health Outcomes and Research Enterprise (SHORE), University of Rochester, Rochester, NY, USA
    Search for more papers by this author
  • Shaji K. Kumar

    1. Transplant Center, Mayo Clinic, Rochester, MN, USA
    2. Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
    Search for more papers by this author

  • Conflict of Interest: No relevant conflict of interest to declare.

Abstract

Background

Autologous stem cell transplant (ASCT) is the current standard of care for most patients with multiple myeloma (MM) who are transplant eligible, yet the timing of ASCT is disputed due to a similar overall (OS) and progression-free survival with an early ASCT (eASCT) or a delayed ASCT (dASCT) approach.

Objective

We developed a decision analytic model to perform cost-effectiveness analysis of the two commonly used treatment strategies for MM.

Methods

Data on disease progression and treatment effectiveness came from 2001 to 2008 cohort treated at the Mayo Clinic and from published studies. Cost analysis was performed from a third-party payer perspective.

Results

The Consumer Price Index adjusted 2012 costs of eASCT and dASCT were $249 236 and $262 610, respectively. eASCT cohort had a benefit of 1.96 quality-adjusted life years (QALYs), 0.23 QALYs more than dASCT, implying that eASCT is preferred (dominant) over dASCT. The most critical variables in one-way sensitivity analysis were treatment-related mortality and OS associated with eASCT strategy.

Conclusions

We conclude that eASCT could potentially be a relatively cost-effective treatment option for appropriate patients with MM, and these results would help patients, providers, and payers in decision making for timing of ASCT.

Ancillary