Abstract
In order to contain costs, MDs must first identify the clinical factors contributing to increased resource utilization associated with an autologous stem cell transplant.
We performed a retrospective clinical and cost analysis of all autologous transplants performed at Dartmouth- Hitchcock Medical Center over a 30 month period (2002-2004) and identified patients who had a prolonged length of stay > 25 d (PLOS). We pinpointed the clinical characteristics and hospital course of each patient to identify trends. The hospital cost-accounting system highlighted resource utilization and costs of the transplants, allowing a comparison between patients with a PLOS and all other transplant patients.
PROLONGED LENGTH OF STAY (PLOS)
| Results: . | All Patients . | LOS < 25 days . | LOS > 25 days . |
|---|---|---|---|
| # of patients | 87(100%) | 58 (67%) | 29 (33%) |
| LOS (days) | |||
| Mean (Median) | 24 (22) | 20 (20) | 31 (31) |
| DISEASE (n = no. of patients) | |||
| AML | 14 | 9 | 5 |
| HD/NHL | 44 | 24 | 20 |
| MM | 28 | 25 | 3 |
| Other (ITP) | 1 | 1 | |
| ENGRAFTMENT (median) | |||
| ANC > 500 (Platelets > 20K) | 12 (18) | 11 (16) | 13 (27) |
| TRANSFUSIONS UNITS /PT (median) | |||
| RBC /Platelets > 20 | 4 (3) | 3 (2) | 7 (7) |
| PARENTAL NUTRITION (TPN) # of days (median) | 9 | 6 | 14 |
| TOXICITIES >= GRADE 3 NCI (Common Toxicitity Criteria) | |||
| Nausea and Vomiting | 36% | 77% | |
| Diarrhea | 9% | 45% | |
| Mucositis | 36% | 41% | |
| Anorexia | 57% | 83% | |
| INFECTION RATE | 10% | 34% | |
| ICU TRANSFER | 3% | 3% |
| Results: . | All Patients . | LOS < 25 days . | LOS > 25 days . |
|---|---|---|---|
| # of patients | 87(100%) | 58 (67%) | 29 (33%) |
| LOS (days) | |||
| Mean (Median) | 24 (22) | 20 (20) | 31 (31) |
| DISEASE (n = no. of patients) | |||
| AML | 14 | 9 | 5 |
| HD/NHL | 44 | 24 | 20 |
| MM | 28 | 25 | 3 |
| Other (ITP) | 1 | 1 | |
| ENGRAFTMENT (median) | |||
| ANC > 500 (Platelets > 20K) | 12 (18) | 11 (16) | 13 (27) |
| TRANSFUSIONS UNITS /PT (median) | |||
| RBC /Platelets > 20 | 4 (3) | 3 (2) | 7 (7) |
| PARENTAL NUTRITION (TPN) # of days (median) | 9 | 6 | 14 |
| TOXICITIES >= GRADE 3 NCI (Common Toxicitity Criteria) | |||
| Nausea and Vomiting | 36% | 77% | |
| Diarrhea | 9% | 45% | |
| Mucositis | 36% | 41% | |
| Anorexia | 57% | 83% | |
| INFECTION RATE | 10% | 34% | |
| ICU TRANSFER | 3% | 3% |
Major contributors to costs included nursing/daily room charge costs (39%), pharmacy (39%), Blood Bank (6%), Laboratory (12%), and other costs (3%). The average daily costs are $4252.
The PLOS cohort had grade > 3 toxicity, increased infection rate, engrafted later and required more transfusional support. 1 pt was transferred to the ICU for temporary management. Of the 29 patients identified with PLOS, none died and all were discharged from the hospital. 45% of NHL/HD patients experienced a prolonged LOS, representing 68% of the PLOS cohort. The median LOS<25d is 20d and the median LOS>25d is 30.5d. At an average daily cost of $4252, these additional 10.5 days of hospitalization costs are substantial. Based on these findings, identification of factors underlying PLOS in the NHL/HD cohort may provide the key to minimizing cost of autologous stem cell transplant. Accordingly, we are assessing the impact of age, number of pre-transplant treatment regimens, number of peripheral blood stem cells reinfused, use of IL-2 for post-transplant immune modulation, and the day 15 absolute lymphocyte count on LOS in this population.
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