Pilot study of patient and caregiver out-of-pocket costs of allogeneic hematopoietic cell transplantation

• Published in: Bone marrow transplantation (Basingstoke) Vol. 48; no. 6; pp. 865 - 871
• Main Authors: MAJHAIL, N. S, RIZZO, J. D, OMONDI, N, PEDERSEN, T. L, MURPHY, E, PEDERSON, K, HAHN, T, LEE, S. J, MCCARTHY, P. L, AMMI, M, DENZEN, E, DREXLER, R, FLESCH, S, JAMES, H
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.06.2013
• Subjects: Adult; Aged; Allografts; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Bone marrow; Bone marrow, stem cells transplantation. Graft versus host reaction; Caregivers; Caregivers - economics; Costs; Costs and Cost Analysis; Diaries; Economic aspects; Family income; Female; Follow-Up Studies; Government programs; Hematopoietic Stem Cell Transplantation - economics; Hematopoietic stem cells; Humans; Income; Insurance; Insurance, Health - economics; Male; Medicaid; Medical sciences; Middle Aged; Patients; Pilot Projects; Polls & surveys; Practice; Services; Stem cell transplantation; Taxation; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplants & implants; United States; Human; Costs; Hematology; Stem cell; out-of-pocket expenses; Caregiver; Hematopoietic cell; Homograft; allogeneic hematopoietic cell transplantation; Allogeneic hematopoietic stem cell transplantation; Health economy; financial impact; Graft; Economic aspect
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/bmt.2012.248

Patient/caregiver out-of pocket costs associated with hematopoietic cell transplantation (HCT) are not well known. We conducted a pilot study to evaluate patient/caregiver out-of-pocket costs in the first 3 months after allogeneic HCT. Thirty patients were enrolled at three sites. Before HCT, participants completed a baseline survey regarding household income and insurance coverage. Subsequently, they maintained a paper-based diary to track daily out-of-pocket expenses for the first 3 months after HCT. Telephone interviews were conducted to follow-up on the missing/incomplete diaries and on study completion. Twenty-five patients/caregivers completed the baseline survey. Among these, the median pre-tax household income was $66 500 (range, $30-$375 000) and 48% had to temporarily relocate close to the transplant center. Insurance coverage was managed care plan (56%), Medicaid (20%), Medicare (17%) and other (8%). Twenty-two patients/caregivers completed 4 diaries; the median out-of-pocket expenses were $2440 (range, $199-$13 769). Patients/caregivers who required temporary lodging had higher out-of-pocket expenses compared with those who did not (median, $5247 vs $716). Patients/caregivers can incur substantial out-of-pocket costs over the first 3 months, especially if they need to temporarily relocate close to the transplant center. Our study lays the foundation for future research on the early and long-term financial impact of allogeneic HCT on patients/caregivers.