Presentation (CTI)

OBJECTIVES: Allo-HCT is an effective treatment for multiple hematologic malignancies. This research explores the overall cost burden of allo-HCT in the United States.
METHODS: Six private and institutional payers in the United States were interviewed in 2022.
RESULTS: According to the payers, on average, an allo-HCT procedure costs between $180,000 and $250,000 based on the transplant type. Among various transplant types, the preferred and most cost-effective modality is haploidentical transplantation using post-transplant cyclophosphamide for Graft-versus-host disease (GvHD) prevention. With about 11,800 allo-HCTs performed in 2022 in the United States (interviewed payer estimates), the cost burden for allo-HCT is about $2.5 billion. Of the total procedure cost, pre-HCT (e.g., physician consulting, medical exams), hospital admission/transplant, and post-transplant (e.g., drug treatment, but excluding severe complications) costs account for 3-10%, 65-75%, and 20-25%, respectively. However, post-transplant complications (e.g., infections, severe GvHD, PGF) cause additional burdens due to higher medication/secondary procedure costs and prolonged hospital stays. In patients with a relapse, the additional cost of treatment (i.e., frequent transfusion support and high-cost medications) can be $70,000-$90,000. In patients with severe complications (e.g., multiple infections, severe GvHD needing extended intensive care), the additional cost can be $150,000-$200,000. For managing poor graft function (PGF), the cost can range from $4,000 for N-acetyl-l-cysteine (NAC) treatment to as high as $600,000 for CAR-T therapy, while a second transplantation can cost $250,000. With the PGF incidence of 7% post-allo-HCT and most PGF patients receiving cell-based therapy, the additional cost burden estimated for managing PGF is estimated at about $130 million.
CONCLUSIONS: Allo-HCT procedures cause a high-cost burden in the United States, with varying costs based on transplant type. The significant drivers of cost are post-transplant complications leading to prolonged hospitalization and additional treatment burden.