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document
Predicting the costs of allogeneic sibling stem-cell transplantation : results from a prospective , multicenter , French study . BACKGROUND Allogeneic hematopoietic stem-cell transplantation is a widely used , cost-intensive procedure . Our purpose was to estimate costs and determine cost predictors . METHODS We used data from a prospective French study comparing four doses of immunoglobulins . Resource use of hematopoietic stem-cell transplant recipients during the first 6 months posttransplant , both inpatient and ambulatory costs , in 85 patients from five centers were collected prospectively and costed . Baseline data and clinical events were retrieved . Protocol-driven costs were excluded . Multivariable analysis evaluated the association between costs and patient 's pretransplant status and transplant-related complications . Because of the absence of differences in outcome among the four randomization groups , cost data for all patients were pooled . RESULTS Total costs per patient were the following : mean 76,237 Euros ; standard deviation 32,565 Euros ; median 69,516 Euros ; range 183,758 to 14,761Euros . The major cost driver was hospital days . No association was found between costs and baseline status . The " predictors " of higher costs ( adding an average 20,000 Euros/patient ) were the occurrence of transplant-related complications : graft-versus-host disease and repeated infections that were unpredictable before transplant in this homogeneous group of patients . CONCLUSION Our data highlight the discrepancy between the Diagnosis Related Group prospective payment system and actual costs . The actual cost of geno-identical stem-cell transplantation results from posttransplant complications that can not be predicted prospectively and require ex post cost adjustment .
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Intervention_Surgical
allogeneic sibling stem-cell transplantation
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Intervention_Surgical
Allogeneic hematopoietic stem-cell transplantation
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Intervention_Educational
data from a prospective French study
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Intervention_Pharmacological
immunoglobulins
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Outcome_Other
costs
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Outcome_Other
costs
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Outcome_Other
cost predictors
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Outcome_Other
Multivariable analysis
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Outcome_Other
costs
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Outcome_Physical
patient 's pretransplant status
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Outcome_Physical
transplant-related complications
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Outcome_Other
cost data
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Outcome_Other
Total costs
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Outcome_Other
costs
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Outcome_Physical
baseline status
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Outcome_Physical
transplant-related complications
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Outcome_Physical
repeated infections
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Outcome_Other
actual costs
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Outcome_Other
actual cost
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Participant_Condition
allogeneic sibling stem-cell transplantation
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Participant_Condition
hematopoietic stem-cell transplant recipients
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Participant_Sample-size
85
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Participant_Condition
pretransplant status and transplant-related complications .