OBJECTIVES

: Limited information is available on cost associated with AHSCT and in particular those detailing pre-transplant chemotherapy and post-transplant follow-up care. The aim of this study was to estimate the average hospital cost per patient of AHSCT, pre- AHSCT chemotherapy cost and the 6-month transplant follow-up care cost.

METHODS

: A retrospective study of patients with RR B-cell ALL (acute lymphoblastic leukemia) at ages 3 and 25 was performed from French hospital database (PMSI) 2013 to 2016. Hospital stays were selected with the ICD10 code CIM C910 "Acute lymphoblastic leukemia" in position of: Principal Diagnosis (PD) or Related Diagnosis (RD) or Associated Diagnosis between 01/01/2013 and 01/01/2014 excluding stays with a Nelarabine administration. Refractory patients could not be identified in the database. Relapsed patients were defined as patients by 2 criteria: (a) at least one complete cycle of chemotherapy prior to transplant (b) bone marrow biopsy followed by hospitalization.

For each allograft identified with CCAM (Classification Commune des Actes Médicaux) procedure FEFFL009 "intravenous injection of a cell therapy for transplant", a cost evaluation per stay and patient (€, 2017) was calculated according to the French health service perspective by detailing: the cost of pre- AHSCT chemotherapy, cost of transplant and the cost of follow-up.

RESULTS

: The prevalence of AHSCT refractory LAL was 126 patients in the PMSI. The median transplant cost per patient was €92,740 (€38,746 - €283,596), the pre-AHSCT chemotherapy median cost was €122,266 (€415 -€344,116) and the follow-up median cost was € 8,467 (€ 628 - €74,081). The mean transplant cost per patient was € 96,738(±€33,758), the pre AHSCT chemotherapy mean cost was €133,319 (±€67,659) and the follow-up mean cost was € 15,676(±€16,940).

CONCLUSIONS

: The study showed that the economic burden of AHSCT in LAL patients, based on the hospital costs, is significant