Cost-effectiveness and clinical outcomes of double versus single cord blood transplantation in adults with acute leukemia in France.
Fiche publication
Date publication
mars 2014
Auteurs
Membres identifiés du Cancéropôle Est :
Pr DECONINCK Eric
Tous les auteurs :
Labopin M, Ruggeri A, Gorin NC, Gluckman E, Blaise D, Mannone L, Milpied N, Yakoub-Agha I, Deconinck E, Michallet M, Fegueux N, Socie G, Nguyen S, Cahn JY, de Revel T, Garnier F, Faucher C, Taright N, Kenzey C, Volt F, Bertrand D, Mohty M, Rocha V
Lien Pubmed
Résumé
Double cord blood transplantation extends the use of cord blood to adults for whom a single unit is not available, but the procedure is limited by its cost. To evaluate outcomes and cost-effectiveness of double compared to single cord blood transplantation, we analyzed 134 transplants in adults with acute leukemia in first remission. Transplants were performed in France with reduced intensity or myeloablative conditioning regimens. Costs were estimated from donor search to 1 year after transplantation. A Markov decision analysis model was used to calculate quality-adjusted life-years and cost-effectiveness ratio within 4 years. The overall survival at 2 years after single and double cord blood transplants was 42% versus 62%, respectively (P=0.03), while the leukemia-free-survival was 33% versus 53%, respectively (P=0.03). The relapse rate was 21% after double transplants and 42% after a single transplant (P=0.006). No difference was observed for non-relapse mortality or chronic graft-versus-host-disease. The estimated costs up to 1 year after reduced intensity conditioning for single and double cord blood transplantation were euro 165,253 and euro191,827, respectively. The corresponding costs after myeloablative conditioning were euro 192,566 and euro 213,050, respectively. Compared to single transplants, double cord blood transplantation was associated with supplementary costs of euro 21,302 and euro 32,420 up to 4 years, but with increases in quality-adjusted life-years of 0.616 and 0.484, respectively, and incremental cost-effectiveness ratios of euro 34,581 and euro66,983 in the myeloablative and reduced intensity conditioning settings, respectively. Our results showed that for adults with acute leukemia in first complete remission in France, double cord transplantation is more cost-effective than single cord blood transplantation, with better outcomes, including quality-adjusted life-years.
Référence
Haematologica. 2014 Mar;99(3):535-40