Cost-effectiveness and clinical outcomes of double versus single cord blood transplantation in adults with acute leukemia in France

Myriam Labopin (1, 2) , Annalisa Ruggeri (3, 4, 1) , Norbert Claude Gorin (5) , Eliane Gluckman (3) , Didier Blaise (6) , Lionel Mannone (7) , Noël Milpied (8) , Ibrahim Yakoub Agha (9) , Eric Deconinck (10) , Mauricette Michallet (11) , Nathalie Fegueux (12) , Gérard Socie (13) , Stephanie Nguyen (14) , Jean Yves Cahn (15) , Thierry de Revel (16) , Federico Garnier (17) , Catherine Faucher (17) , Namik Taright (18) , Chantal Kenzey (3) , Fernanda Volt (3) , Dominique D. Bertrand (19) , Mohamad Mohty (2, 1) , Vanderson Rocha (20, 3)

1 CHU Saint-Antoine [AP-HP]
2 UMRS893 - Centre de Recherche Saint-Antoine
3 Eurocord
4 Università degli Studi di Roma Tor Vergata [Roma] = University of Rome Tor Vergata
5 CEREST-TC [CHU Saint-Antoine]
6 IPC - Institut Paoli-Calmettes
7 Hôpital l'Archet
8 Hôpital Haut-Lévêque [CHU Bordeaux]
9 Hôpital Claude Huriez [Lille]
10 Hôpital JeanMinjoz
11 Hôpital Edouard Herriot [CHU - HCL]
12 CHU - Hôpital Lapeyronie [Montpellier]
13 Hôpital Saint-Louis
14 CHU Pitié-Salpêtrière [AP-HP]
15 Hôpital Michallon
16 Hôpital d'Instruction des Armées Percy
17 Agence de la biomédecine [Saint-Denis la Plaine]
18 DIM Paris
19 Centre national gestion Paris
20 Churchill Hospital

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.

Domaines: Hématologie; Cancer

Myriam Labopin, Annalisa Ruggeri, Norbert Claude Gorin, Eliane Gluckman, Didier Blaise, et al.. Cost-effectiveness and clinical outcomes of double versus single cord blood transplantation in adults with acute leukemia in France. Haematologica, 2014, 99 (3), pp.535-540. ⟨10.3324/haematol.2013.092254⟩. ⟨hal-01325413⟩