Health care utilization and cost among pediatric patients receiving unrelated donor allogeneic hematopoietic cell transplantation.

The costs associated with allogeneic hematopoietic cell transplantation (alloHCT) are high. Differences in costs and healthcare utilization among potential donor sources for alloHCT are not well characterized in pediatric recipients of alloHCT. One potential reason for these high costs could be the donor source of hematopoietic cells. In this retrospective study, inpatient costs, outpatient costs, and markers of healthcare utilization associated with unrelated donor alloHCT for malignant and non-malignant disease were analyzed for 131 pediatric patients during the first year post-transplant, for whom the donor sources were 38% umbilical cord blood (UCB), 14% unmanipulated peripheral blood stem cell (PBSC), 26% bone marrow (BM), and 22% PBSC with CD-34 selection. The median cost per day survived (through day +365) was lowest for patients receiving PBSC with CD-34 selection $926 (322-5316) as compared to UCB $1918 (491-107,93), unmanipulated PBSC $1516 (630-27,516), and BM $1205 (506-11,181) (p = 0.010). For non-malignant alloHCT, UCB had the highest costs per day survived $1530 (491-793) and PBSC with CD-34 selection had the lowest at $482 (322-3092) (p < 0.001). In a multivariable model for costs per day survived, high-risk disease (p = 0.009) and graft failure (p < 0.001) were significantly associated with higher cost and alloHCT between 2010 and 2015 as compared to 2005 and 2009 (p = 0.017) was significantly associated with lower cost per day survived. This study illustrates important differences in cost and healthcare utilization among the different donor sources used for unrelated alloHCT.