Cost Savings With Treosulfan and Fludarabine (Treo/Flu) vs. Busulfan and Fludarabine (Bu2/Flu) Conditioning Regimen in Patients Undergoing Allogeneic HSCT for Acute Myeloid Leukemia (AML) or Myelodysplastic Syndrome (MDS)
Author(s)
Ryan Haumschild, PharmD, MS, MBA1, Mark Fosdal, DHSc, PA-C2, Patrick DeMartino, MD, MPH3;
1Emory Healthcare and Winship Cancer Institute, Atlanta, GA, USA, 2Medexus, Kirland, WI, USA, 3Oregon Health & Science University, Portland, OR, USA
1Emory Healthcare and Winship Cancer Institute, Atlanta, GA, USA, 2Medexus, Kirland, WI, USA, 3Oregon Health & Science University, Portland, OR, USA
Presentation Documents
OBJECTIVES: To compare cost savings from avoided complications with treosulfan + fludarabine (Treo/Flu) vs. busulfan + fludarabine (Bu2/Flu) conditioning regimens in patients undergoing allogeneic haematopoietic stem cell transplantation (allo-HSCT) for acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS).
METHODS: Phase III trial (Beelen et. al, 2022) comparing Treo/Flu vs. Bu2/Flu conditioning regimen was used to gather outcomes data: event free survival (EFS), overall survival (OS), non-relapse mortality (NRM), and rate of key complications: acute and chronic graft vs. host disease (aGVHD/cGVHD), relapse, graft failure, severe veno-occlusive disease (VOD) and mucositis. Cost of key complications except graft failure retrieved from peer reviewed literature and inflation adjusted to 2024 USD. Graft failure costs estimated using EncoderPro “adjusted total” payment rates for allo-HSCT (DRG 14) for 30 hospitals based on total number of allogeneic transplants as reported by National Marrow Donor Program .Costs associated with complications of allo-HSCT calculated by multiplying costs/payment rates by rate of complications with Treo/Flu vs. Bu2/Flu regimens from a health system perspective.
RESULTS: Treo/Flu demonstrated a significant improvement in EFS (Δ 14.5%), OS (Δ 12.5%), and NRM (Δ -8.4%), vs. Bu2/Flu. Rate of key complications were lower with Treo/Flu vs. Bu2/Flu: • aGVHD: 52.8% vs 57.2% • cGVHD : 19.8% vs. 28.6% • Relapse: 22.0% vs. 25.2% • Graft failure: 0.4% vs 3.2% • Severe VOD: 0% vs. 0.4% • Grades 3-4 Mucositis: 5.9% vs. 7.4%
Estimating cost implications of fewer complications suggests a reduction in inflation adjusted costs of ~$6.1M over 2 years to the healthcare system for every 100 patients treated with the Treo/Flu relative to Bu2/Flu agnostic of costs of conditioning regimens.
CONCLUSIONS: Treo/Flu conditioning regimen results in substantial savings from avoided complications vs. Bu2/Flu. This is likely a conservative estimate of the value of Treo/Flu given this analysis does not include QALY gains from improved OS and EFS.
METHODS: Phase III trial (Beelen et. al, 2022) comparing Treo/Flu vs. Bu2/Flu conditioning regimen was used to gather outcomes data: event free survival (EFS), overall survival (OS), non-relapse mortality (NRM), and rate of key complications: acute and chronic graft vs. host disease (aGVHD/cGVHD), relapse, graft failure, severe veno-occlusive disease (VOD) and mucositis. Cost of key complications except graft failure retrieved from peer reviewed literature and inflation adjusted to 2024 USD. Graft failure costs estimated using EncoderPro “adjusted total” payment rates for allo-HSCT (DRG 14) for 30 hospitals based on total number of allogeneic transplants as reported by National Marrow Donor Program .Costs associated with complications of allo-HSCT calculated by multiplying costs/payment rates by rate of complications with Treo/Flu vs. Bu2/Flu regimens from a health system perspective.
RESULTS: Treo/Flu demonstrated a significant improvement in EFS (Δ 14.5%), OS (Δ 12.5%), and NRM (Δ -8.4%), vs. Bu2/Flu. Rate of key complications were lower with Treo/Flu vs. Bu2/Flu: • aGVHD: 52.8% vs 57.2% • cGVHD : 19.8% vs. 28.6% • Relapse: 22.0% vs. 25.2% • Graft failure: 0.4% vs 3.2% • Severe VOD: 0% vs. 0.4% • Grades 3-4 Mucositis: 5.9% vs. 7.4%
Estimating cost implications of fewer complications suggests a reduction in inflation adjusted costs of ~$6.1M over 2 years to the healthcare system for every 100 patients treated with the Treo/Flu relative to Bu2/Flu agnostic of costs of conditioning regimens.
CONCLUSIONS: Treo/Flu conditioning regimen results in substantial savings from avoided complications vs. Bu2/Flu. This is likely a conservative estimate of the value of Treo/Flu given this analysis does not include QALY gains from improved OS and EFS.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE70
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology