Outpatient Stem Cell Transplants for Breast Cancer
Creators: name: University Of California Office Of The President
Publisher: name: University of California Office of the President
publisherIdentifier: https://ror.org/00dmfq477
publisherIdentifierScheme: ROR
Year: 2024

description: High-dose chemotherapy with bone marrow or stem cell transplant is a treatment that has been increasingly recommended to women with advanced (metastatic) or high-risk primary breast cancer. Studies have shown that this therapy, which uses very high doses of chemotherapy, may lead to better results in women with high-risk disease. The technique of stem cell transplant has been developed over the past decade to allow the use of extremely high doses of chemotherapy. Stem cells are collected, frozen and then used to rescue blood counts following high-dose chemotherapy. However, a major barrier to more widespread use of this treatment is the very high associated costs, typically ranging from $100,000 to $150,000. Because of this high cost, there has been a great deal of resistance on the part of insurers to include this procedure as a covered benefit. Controversy surrounding this has manifested itself by lawsuits, arbitration hearings, testimony before Congress, and attempts at legislation in many states. It is clear that no matter how successful this therapy is, it will have little impact for the majority of women who might benefit from it unless it is more widely available. More widespread availability, in turn, depends on reduction of total costs. One major source of the high cost has been the traditional need for prolonged inpatient hospitalization. However, in the last few years it has become possible to deliver this therapy in a less costly setting. At Scripps Clinic, early discharge programs have been developed which safely and effectively reduce the total duration of hospitalization as well as the total costs associated with this procedure. We have treated over 150 patients with high-dose chemotherapy and stem cell transplants in an outpatient clinic. Preliminary results demonstrate that this program is extremely safe (procedure-related death rate of less than 1.5 %) and highly acceptable to patients. Preliminary financial analysis suggests a 35% to 43 % reduction in total charges for patients treated in the outpatient setting. However, there is no information on the financial impact of this type of program on the patients and their families. Further, effects on patients emotional and psychological health have not been adequately examined.
 
 
 
 
 
 
 
 We propose to conduct a detailed analysis of the financial impact of outpatient transplantation for breast cancer by comparing the total hospital and clinic costs associated with stem cell transplantation among patients receiving traditional inpatient care and those receiving the identical treatment in this innovative model of outpatient care. In addition, we will examine the financial impact on the patients and their families in the two settings to determine whether any shift in costs from insurers to patients and families is occurring. We will also compare the "quality of life" and psychological impact of treatment for the different treatment settings. If outpatient transplants are shown to reduce total costs without unduly burdening patients or their families, substantial barriers to more widespread use of this potentially life-saving therapy should be reduced.