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Abstract

 ePoster IMPACT OF CELLULAR THERAPY ON THE ECONOMIC BURDEN AND SURVIVAL FOLLOWING RELAPSE AFTER HLA IDENTICAL HEMATOPOIETIC STEM CELL TRANSPLANTATION FOR ACUTE LEUKEMIA AND MYELODYSPLASTIC SYNDROME.

Abstract: P371

Type: Poster Presentation

Presentation during EHA22: On Friday, June 23, 2017 from 17:15 - 18:45

Location: Poster area (Hall 7)

Background

Relapse following allogeneic hematopoietic stem cell transplant (aHSCT) is associated to a very poor outcome and remains an unmet medical needs. The impact of treatment approach on costs and survival remains unknown. The development of innovative cellular therapy for the treatment of relapse following aHSCT may change its dismal outcome but the cost of such intervention has prohibited its large-scale development. 

Aims
The objective of this study was to measure the economic burden associated with the management of relapse following aHSCT and to evaluate the impact of treatment choice on survival and health care costs.  

Methods
A retrospective medical chart review was conducted at Maisonneuve-Rosemont Hospital (HMR) after research and ethic committee approval. Patients were selected using the Hematopoietic Stem Cell Transplant (HSCT) program database. Eligible patients were diagnosed with acute leukemia (AL) or MDS and relapsed following a HLA identical aHSCT between January 1st 2011 and December 31st 2014. Patients’ and disease characteristics and relapse-related health care resource utilization were collected from the date of post transplant relapse until death or last follow-up. Canadian unit costs for each intervention/treatment were obtained from literature and governmental publications.

Results

During the study period, 645 HSCT were performed at HMR, 303 were allogeneic. A total of 36 patients met the inclusion criteria and were included in the analysis. 32 recipients were diagnosed with AL and 4 with MDS. Treatment approaches following aHSCT relapse were divided in three groups according to patient and physician choices: group 1 received supportive care (n=9), group 2 received chemotherapy or tyrosine kinase inhibitors (n=21) and group 3 received a cellular based therapy, either donor lymphocyte infusion (DLI) or a second aHSCT (n=6). The mean cost of care per patient per month was C$20,239 (SD=17,079). The median survival following relapse for the entire cohort was 12.4 months (SD=2.8).  For group 1, 2 and 3, the mean cost of care per patient per month was C$17,436 (SD=16,447), C$22,914 (SD=18,474) and C$15,082 (SD=12,954), respectively. The median survival was 4.0 months (SD=2.0), 7.2 months (SD=1.6), and 44.6 months (SD=8.4), for treatment group 1,2 and 3 respectively (Fig.1). 

Conclusion

Relapse following AHSCT is associated to a poor prognosis and survival and to significant use of health care resources. Despite the selection bias, only patients who received cellular based therapy, either DLI or another HSCT, enjoyed a prolonged survival. Healthcare resources devoted to the care of patients in relapse post AHSCT provide a comparative basis for cost efficiency analysis in the development of innovative cellular therapy.

Session topic: 35. Quality of life, palliative care, ethics and health economics

Keyword(s): Relapse, Cost analysis, Cellular therapy

Abstract: P371

Type: Poster Presentation

Presentation during EHA22: On Friday, June 23, 2017 from 17:15 - 18:45

Location: Poster area (Hall 7)

Background

Relapse following allogeneic hematopoietic stem cell transplant (aHSCT) is associated to a very poor outcome and remains an unmet medical needs. The impact of treatment approach on costs and survival remains unknown. The development of innovative cellular therapy for the treatment of relapse following aHSCT may change its dismal outcome but the cost of such intervention has prohibited its large-scale development. 

Aims
The objective of this study was to measure the economic burden associated with the management of relapse following aHSCT and to evaluate the impact of treatment choice on survival and health care costs.  

Methods
A retrospective medical chart review was conducted at Maisonneuve-Rosemont Hospital (HMR) after research and ethic committee approval. Patients were selected using the Hematopoietic Stem Cell Transplant (HSCT) program database. Eligible patients were diagnosed with acute leukemia (AL) or MDS and relapsed following a HLA identical aHSCT between January 1st 2011 and December 31st 2014. Patients’ and disease characteristics and relapse-related health care resource utilization were collected from the date of post transplant relapse until death or last follow-up. Canadian unit costs for each intervention/treatment were obtained from literature and governmental publications.

Results

During the study period, 645 HSCT were performed at HMR, 303 were allogeneic. A total of 36 patients met the inclusion criteria and were included in the analysis. 32 recipients were diagnosed with AL and 4 with MDS. Treatment approaches following aHSCT relapse were divided in three groups according to patient and physician choices: group 1 received supportive care (n=9), group 2 received chemotherapy or tyrosine kinase inhibitors (n=21) and group 3 received a cellular based therapy, either donor lymphocyte infusion (DLI) or a second aHSCT (n=6). The mean cost of care per patient per month was C$20,239 (SD=17,079). The median survival following relapse for the entire cohort was 12.4 months (SD=2.8).  For group 1, 2 and 3, the mean cost of care per patient per month was C$17,436 (SD=16,447), C$22,914 (SD=18,474) and C$15,082 (SD=12,954), respectively. The median survival was 4.0 months (SD=2.0), 7.2 months (SD=1.6), and 44.6 months (SD=8.4), for treatment group 1,2 and 3 respectively (Fig.1). 

Conclusion

Relapse following AHSCT is associated to a poor prognosis and survival and to significant use of health care resources. Despite the selection bias, only patients who received cellular based therapy, either DLI or another HSCT, enjoyed a prolonged survival. Healthcare resources devoted to the care of patients in relapse post AHSCT provide a comparative basis for cost efficiency analysis in the development of innovative cellular therapy.

Session topic: 35. Quality of life, palliative care, ethics and health economics

Keyword(s): Relapse, Cost analysis, Cellular therapy

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