Cost-effectiveness and costutility studies of HCT versus chemotherapy
| Study/disease . | Category . | Chemotherapy/no transplant . | HCT . | Difference . | Incremental cost-effectiveness ratio . | Interpretation . |
|---|---|---|---|---|---|---|
| Dufoir et al42 /AML | Costs | 304 486 FF | 424 696 FF | 120 210 FF | 122 421 FF/year | Allo-HCT cost-effective in AML-CR1 |
| Survival | 2.806 years | 3.785 years | 0.979 years | |||
| Welch et al63 /AML | Costs | $136 000 USD | $193 000 USD | $57 000 USD | $52 777 USD/year | Allo-HCT cost-effective for acute nonlymphocytic leukemia |
| Survival | 2.24 years | 3.32 years | 1.08 years | |||
| Barr et al40 /AML | Costs | $51 800 CAN | $100 600 CAN | $48 800 CAN | $29 221 CAN/year | Allo-HCT cost-effective for AML in CR2 |
| Survival | 0.57 life-years | 2.24 life-years | 1.67 life-years | |||
| Barr et al40 /ALL | Costs | $102 800 CAN | $92 000 CAN | $10 800 CAN | Cost savings with HCT for ALL in CR1 | |
| Survival | 3.32 life-years | 3.69 life-years | 0.37 life-years | |||
| Lee et al18 /CML | Costs | $61 800 USD (IFN) | $333 600 USD | $271 800 USD (IFN) | $51 771 USD/QALY (IFN), $55 449 USD/QALY (Hydrea) | URD transplant is cost-effective for CML-CP compared with IFN or Hydrea |
| $31 400 USD (Hydrea) | $302 200 USD (Hydrea) | |||||
| Survival | 4.7 QALY (IFN)/4.5 QALY (Hydrea) | 9.95 QALY | 5.25 QALY (IFN) | |||
| 5.45 QALY (Hydrea) | ||||||
| Costa et al64 /acute leukemia | Costs | $20 702 USD (no transplant) | $69 830 USD (URD BM/PBSC) | $49 693 USD (URD BM/PBSC) | $16 346 USD/life-year (URD BM/PBSC) | Both URD BM/PBSC and cords are cost-effective compared with no transplants |
| $92 330 USD (cord) | $72 157 USD (cord) | |||||
| Survival | 0.75 life-years (no transplant) | 3.04 life-years (BM/PBSC) | $34 360 USD/life-year (cord) | |||
| 2.10 life-years (cord) | ||||||
| Skrepnek et al65 /CML-CP (Ph+): 2-y cost-efficacy | Costs | $78 000 USD (imatinib) | $114 000 USD(MUD BMT) | $36 000 USD | MUD BMT is more costly and less efficacious than imatinib for CML during the first 2 y | |
| Survival | 0.91 (imatinib) | 0.44 (MUD BMT) | −0.47 | |||
| Breitscheidel66 /CML-CP | Costs | €196 836 (imatinib) | €133 403 (MUD HCT) | €63 433 | €77 410/QALY | MUD HCT is less costly and less effective than imatinib over a 5-year time horizon |
| Survival | 4.17 QALY | 3.35 QALY | 0.82 QALY | |||
| Kouroukis et al67 /multiple myeloma | Costs | $1803 CAN (melphalan/prednisone) | $32 320 CAN (autologous HCT) | $30 517 CAN | $18 974 CAN | Autologous HCT cost-effective in patients < 65 years old with myeloma |
| Survival | 2.85 life-years | 4.46 life-years | 1.61 life-years | |||
| Messori et al68 /acute leukemia relapse | Costs | $60 000 USD (chemotherapy) | $150 000 USD (2nd HCT) | $90 000 USD | $52 215 USD/ life-year | 2nd HCT cost-effective for posttransplant relapse of acute leukemia |
| Survival | 0.6 life-years | 2.2 life-years | 1.6 life-years |
| Study/disease . | Category . | Chemotherapy/no transplant . | HCT . | Difference . | Incremental cost-effectiveness ratio . | Interpretation . |
|---|---|---|---|---|---|---|
| Dufoir et al42 /AML | Costs | 304 486 FF | 424 696 FF | 120 210 FF | 122 421 FF/year | Allo-HCT cost-effective in AML-CR1 |
| Survival | 2.806 years | 3.785 years | 0.979 years | |||
| Welch et al63 /AML | Costs | $136 000 USD | $193 000 USD | $57 000 USD | $52 777 USD/year | Allo-HCT cost-effective for acute nonlymphocytic leukemia |
| Survival | 2.24 years | 3.32 years | 1.08 years | |||
| Barr et al40 /AML | Costs | $51 800 CAN | $100 600 CAN | $48 800 CAN | $29 221 CAN/year | Allo-HCT cost-effective for AML in CR2 |
| Survival | 0.57 life-years | 2.24 life-years | 1.67 life-years | |||
| Barr et al40 /ALL | Costs | $102 800 CAN | $92 000 CAN | $10 800 CAN | Cost savings with HCT for ALL in CR1 | |
| Survival | 3.32 life-years | 3.69 life-years | 0.37 life-years | |||
| Lee et al18 /CML | Costs | $61 800 USD (IFN) | $333 600 USD | $271 800 USD (IFN) | $51 771 USD/QALY (IFN), $55 449 USD/QALY (Hydrea) | URD transplant is cost-effective for CML-CP compared with IFN or Hydrea |
| $31 400 USD (Hydrea) | $302 200 USD (Hydrea) | |||||
| Survival | 4.7 QALY (IFN)/4.5 QALY (Hydrea) | 9.95 QALY | 5.25 QALY (IFN) | |||
| 5.45 QALY (Hydrea) | ||||||
| Costa et al64 /acute leukemia | Costs | $20 702 USD (no transplant) | $69 830 USD (URD BM/PBSC) | $49 693 USD (URD BM/PBSC) | $16 346 USD/life-year (URD BM/PBSC) | Both URD BM/PBSC and cords are cost-effective compared with no transplants |
| $92 330 USD (cord) | $72 157 USD (cord) | |||||
| Survival | 0.75 life-years (no transplant) | 3.04 life-years (BM/PBSC) | $34 360 USD/life-year (cord) | |||
| 2.10 life-years (cord) | ||||||
| Skrepnek et al65 /CML-CP (Ph+): 2-y cost-efficacy | Costs | $78 000 USD (imatinib) | $114 000 USD(MUD BMT) | $36 000 USD | MUD BMT is more costly and less efficacious than imatinib for CML during the first 2 y | |
| Survival | 0.91 (imatinib) | 0.44 (MUD BMT) | −0.47 | |||
| Breitscheidel66 /CML-CP | Costs | €196 836 (imatinib) | €133 403 (MUD HCT) | €63 433 | €77 410/QALY | MUD HCT is less costly and less effective than imatinib over a 5-year time horizon |
| Survival | 4.17 QALY | 3.35 QALY | 0.82 QALY | |||
| Kouroukis et al67 /multiple myeloma | Costs | $1803 CAN (melphalan/prednisone) | $32 320 CAN (autologous HCT) | $30 517 CAN | $18 974 CAN | Autologous HCT cost-effective in patients < 65 years old with myeloma |
| Survival | 2.85 life-years | 4.46 life-years | 1.61 life-years | |||
| Messori et al68 /acute leukemia relapse | Costs | $60 000 USD (chemotherapy) | $150 000 USD (2nd HCT) | $90 000 USD | $52 215 USD/ life-year | 2nd HCT cost-effective for posttransplant relapse of acute leukemia |
| Survival | 0.6 life-years | 2.2 life-years | 1.6 life-years |
FF indicates French franc; USD, United States dollars; CAN, Canadian; AML, acute myeloid leukemia; ALL, acute lymphocytic leukemia; CML, chronic myeloid leukemia; CR, clinical remission; CML-CP (Ph+), chronic myeloid leukemia-chronic phase (Ph+); MUD, matched unrelated donor; QALY, quality-adjusted life-years; and MUD SCT, matched unrelated donor stem cell transplant.