Cost Savings with Treosulfan and Fludarabine Conditioning Regimen vs. RIC (Bu2/Flu and Flu/Mel) and MAC Regimens (Bu4/Flu and Bu4/Cy) in Patients Undergoing Allogeneic HSCT for AML or MDS
Author(s)
Ryan Haumschild, MS, MBA1, Mark Fosdal, DHSc, PA-C22, Patrick DeMartino, MD, MPH3;
1Emory Healthcare and Winship Cancer Institute, Atlanta, GA, USA, 2Medexus, Kirkland, WA, USA, 3Oregon Health & Science University, Portland, OR, USA
1Emory Healthcare and Winship Cancer Institute, Atlanta, GA, USA, 2Medexus, Kirkland, WA, USA, 3Oregon Health & Science University, Portland, OR, USA
Presentation Documents
OBJECTIVES: To compare cost savings from avoided complications with treosulfan + fludarabine (Treo/Flu) conditioning regimen vs. commonly used reduced-intensity conditioning (RIC) and myeloablative conditioning (MAC) regimens in patients undergoing allogeneic haematopoietic stem cell transplantation (allo-HSCT) for acute myeloid leukaemia (AML) or myelodysplastic syndrome (MDS).
METHODS: Efficacy outcomes and key complications: acute and chronic graft vs. host disease (aGVHD and cGVHD), relapse, graft failure, and veno-occlusive disease (VOD)] were compared. Data used from Beelen et al. (2022) for Treo/Flu and from Eapen et al. (2018) and Nauffal et al. (2022) for RIC regimens busulfan + fludarabine (Bu2/Flu) and fludarabine + melphalan (Flu/Mel) with or without antithymocyte globulin (+/-ATG), and MAC regimens busulfan + fludarabine (Bu4/Flu+/-ATG) and busulfan + cyclophosphamide (Bu4/Cy). Cost of key complications except graft failure retrieved from published 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 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 the rate of complications associated with each regimen from a health system perspective.
RESULTS: Clinical outcomes were more favourable and rates of key complications were usually lower with Treo/Flu vs. commonly used RIC/MAC regimens, for example, • cGVHD: 19.8% vs. 26.1% (RIC) and 31.2% (MAC) • Graft failure: 0.4% vs. 6.3% (RIC) and 2.3% (MAC).
Estimating cost implications of fewer complications with Treo/Flu suggests a reduction in inflation adjusted cost to the healthcare system over 2 years of ~$16.3M vs. Bu2/Flu+/-ATG, ~$2.6M vs Flu/Mel+/-ATG, ~$10.4M vs. Bu4/Flu+/-ATG, and ~$10.8M vs. Bu4/Cy agnostic of costs of conditioning regimens for every 100 patients treated.
CONCLUSIONS: As treatment evolves to leverage reduced toxicity conditioning (RTC) regimens, Treo/Flu offers clinical benefit and provides cost savings to healthcare systems.
METHODS: Efficacy outcomes and key complications: acute and chronic graft vs. host disease (aGVHD and cGVHD), relapse, graft failure, and veno-occlusive disease (VOD)] were compared. Data used from Beelen et al. (2022) for Treo/Flu and from Eapen et al. (2018) and Nauffal et al. (2022) for RIC regimens busulfan + fludarabine (Bu2/Flu) and fludarabine + melphalan (Flu/Mel) with or without antithymocyte globulin (+/-ATG), and MAC regimens busulfan + fludarabine (Bu4/Flu+/-ATG) and busulfan + cyclophosphamide (Bu4/Cy). Cost of key complications except graft failure retrieved from published 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 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 the rate of complications associated with each regimen from a health system perspective.
RESULTS: Clinical outcomes were more favourable and rates of key complications were usually lower with Treo/Flu vs. commonly used RIC/MAC regimens, for example, • cGVHD: 19.8% vs. 26.1% (RIC) and 31.2% (MAC) • Graft failure: 0.4% vs. 6.3% (RIC) and 2.3% (MAC).
Estimating cost implications of fewer complications with Treo/Flu suggests a reduction in inflation adjusted cost to the healthcare system over 2 years of ~$16.3M vs. Bu2/Flu+/-ATG, ~$2.6M vs Flu/Mel+/-ATG, ~$10.4M vs. Bu4/Flu+/-ATG, and ~$10.8M vs. Bu4/Cy agnostic of costs of conditioning regimens for every 100 patients treated.
CONCLUSIONS: As treatment evolves to leverage reduced toxicity conditioning (RTC) regimens, Treo/Flu offers clinical benefit and provides cost savings to healthcare systems.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE176
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology