The Cost-Effectiveness of Stem Cell Transplantations from Unrelated Donors in Adult Patients with Acute Leukemia

ObjectivesHematopoietic stem cell transplantation is an accepted treatment of hematological malignancies, but the cost-effectiveness of this technology has not been fully explored. This study aims to assess the cost-effectiveness of stem cell transplantation from either cord blood or bone marrow/peripheral blood compared with no transplantation in adult patients with acute leukemias not expected to be cured with chemotherapy.MethodsA systematic review was performed to estimate the efficacy of unrelated cord blood and bone marrow/peripheral blood stem cells (BM/PBSC) transplantations in adults with acute leukemia. A Markov decision analysis model using Monte Carlo simulations was used to calculate the incremental cost-effectiveness ratio (ICER) and 95% confidence intervals (CIs).ResultsThe estimated cumulative survival at 1 and 10 years were 27.9% and 14%, respectively, for cord blood recipientsand 47% and 17.7%, respectively, for BM/PBSC recipients. Using conservative assumptions, the cost per life-year gained compared with no transplantation was US $16,346 (95% CI $8695, $38,006) for BM/PBSC transplantation and US $34,360 (95% CI $23,101, $89,417) for cord blood transplantation.ConclusionAlthough both types of stem cell transplantations are associated with a high short-term mortality and high cost, the cumulative gains in life-years of survivors can be substantial, resulting in ICERs compared with no transplantation that are usually considered acceptable. However there is less certainty about this conclusion with cord blood transplantation.