Costs of care and outcomes for high-dose therapy and autologous transplantation for lymphoid malignancies: Results from the University of Nebraska 1987 through 1991

Charles L. Bennett, Jack L. Armitage, Gregory O. Armitage, Julie M. Vose, Philip J. Bierman, James O. Armitage, James R. Anderson

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Abstract

Purpose and Methods: High-dose therapy with autologous stem-cell support has become common treatment for relapsed or refractory lymphomas. We conducted a study of 178 patients with Hodgkin's disease and 149 patients with non-Hodgkin's lymphoma who received high-dose therapy with stem-cell support. We evaluated the following: (1) whether improvements in outcomes over time found for surgical procedures were also true for a new nonsurgical procedure, autologous bone marrow and peripheral stem-cell transplantation; and (2) whether such a relationship, if it existed, applied to both clinical and economic outcomes. Results: Mortality rates for patients with Hodgkin's disease decreased from 20% in 1987 to 0% in 1991. For non-Hodgkin's lymphoma, the mortality rate decreased from 29% in 1987 to 4% in 1991. Multivariate analyses indicated that the number of previous transplants was the most important factor associated with survival and low-cost care. After controlling for differences in clinical factors, a logistic regression model predicted that patients with Hodgkin's disease had a 20% chance of dying after 30 cases and a 5% chance after 178 cases; patients with non-Hodgkin's disease had a 33% chance of dying after 14 cases and a 5% chance after 149 cases. For patients with Hodgkin's disease, the cost decreased at a rate of 10% per year from 1987 to 1991 (P = .001), while for patients with non- Hodgkin's lymphoma, the cost of transplants decreased at a rate of 8% per year. Conclusion: Survival rates improved and costs of care decreased over time for patients who received high-dose therapy with stem-cell support. These changes are most likely related to improvements in supportive care technologies, better patient selection, and experience of the transplant team.

Original languageEnglish (US)
Pages (from-to)969-973
Number of pages5
JournalJournal of Clinical Oncology
Volume13
Issue number4
DOIs
StatePublished - Apr 1995

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ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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