Cost-effectiveness and clinical outcomes of double versus single cord blood transplantation in adults with acute leukemia in France
Myriam Labopin,
Annalisa Ruggeri,
Norbert Claude Gorin,
Eliane Gluckman,
Didier Blaise,
Lionel Mannone,
Noel Milpied,
Ibrahim Yakoub-Agha,
Eric Deconinck,
Mauricette Michallet,
Nathalie Fegueux,
Gerard Socié,
Stephanie Nguyen,
Jean Yves Cahn,
Thierry de Revel,
Federico Garnier,
Catherine Faucher,
Namik Taright,
Chantal Kenzey,
Fernanda Volt,
Dominique Bertrand,
Mohamad Mohty,
Vanderson Rocha
Affiliations
Myriam Labopin
Sorbonne Universités, UPMC Univ Paris 06, UMR-S938, CDR Saint-Antoine, Paris, France;INSERM, UMR-S938, CDR Saint-Antoine, Paris, France;Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France
Annalisa Ruggeri
Eurocord, Hôpital Saint Louis, University Paris VII, France;Rome Transplant Network, University Tor Vergata, Rome, Italy;Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France
Norbert Claude Gorin
Saint Antoine Hospital, UPMC Univ Paris 06, UMR-S938, CEREST-TC EBMT, Paris, France
Eliane Gluckman
Eurocord, Hôpital Saint Louis, University Paris VII, France
Didier Blaise
Paoli Calmettes Hospital, Marseille, France
Lionel Mannone
L’Archet Hospital, Nice, France
Noel Milpied
Haut-Lévêque Hospital, Pessac, France
Ibrahim Yakoub-Agha
Claude Huriez Hospital, Lille, France
Eric Deconinck
Jean Minjoz Hospital, Besancon, France
Mauricette Michallet
E. Herriot Hospital, Lyon, France
Nathalie Fegueux
Lapeyronie Hospital, Montpellier, France
Gerard Socié
Saint Louis Hospital, Paris, France
Stephanie Nguyen
Pitié Salpetriere Hospital, Paris, France
Jean Yves Cahn
Albert Michallon Hospital, Grenoble, France
Thierry de Revel
Percy Hospital, Clamart, France
Federico Garnier
Agence de la Biomedecine, Paris, France
Catherine Faucher
Agence de la Biomedecine, Paris, France
Namik Taright
DIM, Paris, France
Chantal Kenzey
Eurocord, Hôpital Saint Louis, University Paris VII, France
Fernanda Volt
Eurocord, Hôpital Saint Louis, University Paris VII, France
Dominique Bertrand
Centre National Gestion, Paris, France
Mohamad Mohty
Sorbonne Universités, UPMC Univ Paris 06, UMR-S938, CDR Saint-Antoine, Paris, France;INSERM, UMR-S938, CDR Saint-Antoine, Paris, France;Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France
Vanderson Rocha
Eurocord, Hôpital Saint Louis, University Paris VII, France;Churchill Hospital, University of Oxford, UK
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 € 165,253 and €191,827, respectively. The corresponding costs after myeloablative conditioning were € 192,566 and € 213,050, respectively. Compared to single transplants, double cord blood transplantation was associated with supplementary costs of € 21,302 and € 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 € 34,581 and €66,983 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.
