OBJECTIVES

: To identify patterns of health service utilization among long-term allogeneic and autologous hematopoietic cell transplantation (HCT) recipients, and determine characteristics associated with high-need and high-cost care in a commercially-insured population in the United States.

METHODS

: Latent class analyses were performed on a retrospective cohort of allogeneic (n=436) and autologous (n=888) HCT recipients from the Truven Health Analytics MarketScan® database between 2009 and 2014. We classified care recipients based on the following service use types for a follow-up period of 24 months: Inpatient admissions, length of inpatient stay, emergency room (ER) visits, use of specialist care and primary care. Multivariable logistic regression models were performed to identify demographic and clinical characteristics associated with high-need, high-cost health care resource use pattern. We further assessed total healthcare expenditures by latent class of transplant recipients.

RESULTS

: Four classes of health services users were identified: a specialist outpatient care dominant class (51.8% and 57.3% in allogeneic and autologous HCT cohort, respectively), a primary outpatient care dominant class (10.3% in allogeneic and 25.7% in autologous HCT cohort), a balanced care class (20.6% in allogeneic and 13.5% in autologous HCT cohort) and an inpatient dominant high utilizer class (17.2% in allogeneic HCT and 3.5% in autologous HCT cohort). Average monthly healthcare expenditures among inpatient dominant high utilization were $41,097 and $25,556 for the allogeneic and autologous HCT recipients, respectively, which were two to five times higher compared to other classes. Factors associated with the inpatient dominant high utilizer class among allogeneic HCT recipients were transfusion (OR = 1.87, 95% CI 1.06–3.30) and graft-versus-host-disease (OR = 1.76, 95% CI 1.05–2.94).

CONCLUSIONS

: Based on distinct patterns of post-HCT care utilization, we categorized four classes of health services users, and identified factors associated with high resource utilization and greater health expenditures.