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Clinical trajectories, healthcare resource use, and costs of long-term hematopoietic stem cell transplantation survivors: a latent class analysis.

Purpose: To identify patterns of healthcare utilization in allogeneic and autologous hematopoietic stem cell transplantation (HSCT) recipients and evaluate factors associated with high-need and high-cost post-transplantation care.Methods: Latent class analysis of a retrospective cohort of long-term...

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Published in:Journal of Cancer Survivorship Vol. 14; no. 3; pp. 294 - 305
Main Authors: Zhou, Jifang, Nutescu, Edith A., Han, Jin, Calip, Gregory S.
Format: research Journal Article
Published: Springer Nature Jun2020
Online Access:View this record in EBSCOhost
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      dt: Jun2020
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      pub: Springer Nature
      place: New York, New York
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        10.1007/s11764-019-00842-1
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        atl: Clinical trajectories, healthcare resource use, and costs of long-term hematopoietic stem cell transplantation survivors: a latent class analysis.
      aug:
        au:
          Zhou, Jifang
          Nutescu, Edith A.
          Han, Jin
          Calip, Gregory S.
        affil: Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL, USA
      sug:
        subj:
          Hematopoietic Stem Cell Transplantation Mortality
          Hematopoietic Stem Cell Transplantation Economics
          Immunosuppression Mortality
          Immunosuppression Economics
          Health Resource Utilization Standards
          Female
          Retrospective Design
          Male
          Middle Age
          Human
          Survival Analysis
          Validation Studies
          Comparative Studies
          Evaluation Research
          Multicenter Studies
          Middle Aged: 45-64 years
          Female
          Male
      ab: Purpose: To identify patterns of healthcare utilization in allogeneic and autologous hematopoietic stem cell transplantation (HSCT) recipients and evaluate factors associated with high-need and high-cost post-transplantation care.Methods: Latent class analysis of a retrospective cohort of long-term allogeneic (n = 436) and autologous (n = 888) HSCT survivors within the Truven MarketScan database (2009-2014). We assessed factors associated with the latent classes by comparing post-transplantation healthcare utilization including inpatient admissions and length of stay, emergency room visits, specialist visits, and primary care provider visits.Results: Four utilization classes were identified in allogeneic and autologous HSCT recipients: (i) outpatient specialist care dominant (51.8% and 57.3%), (ii) outpatient primary care dominant (10.3% and 25.7%), (iii) outpatient/inpatient balanced (20.6% and 13.5%), and (iv) inpatient dominant (17.2% and 3.5%). Mean monthly healthcare expenditures in the inpatient dominant utilization class were $41,097 and $25,556 for allogeneic and autologous survivors, respectively, which were two to five times higher compared with other classes during the 2-year post-transplantation period. Factors associated with the high utilization class were transfusion (OR = 1.87, 95% CI 1.06-3.30) and 100-day post-transplant graft-versus-host-disease (OR = 1.76, 95% CI 1.05-2.94) in allogeneic HSCT; higher baseline Charlson comorbidity index (OR = 1.45, 95% CI 1.19-1.76) in autologous HSCT.Conclusion: Based on distinct patterns of healthcare utilization following HSCT, we identified factors associated with higher resource utilization and greater healthcare related expenditures.Implications For Cancer Survivors: Earlier identification of high-cost and high-need HSCT long-term survivors could pave the way for clinicians to offer more continuous engagement in survivorship care delivery.
      pubtype: Academic Journal
      doctype:
        research
        Journal Article
      ougenre: Article
    language: English
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