Mixed outpatient-inpatient model safe, cost-effective for multiple myeloma
The adoption of a novel mixed outpatient-inpatient model has been shown to be cost-effective, safe and feasible for multiple myeloma, according to a recent study.
Researchers implemented a mixed outpatient-inpatient autologous stem cell transplantation at an institution to achieve financial benefit without compromising safety. Eligible patients were given melphalan in the clinic the day prior to being admitted for peripheral blood stem cell reinfusion in a hospital where they stay until recovery of myelosuppression.
A total of 19 patients received high-dose melphalan prior to autologous stem cell transplantation in the year since implementing the mixed model. Of these, 18 successfully received melphalan in the outpatient clinic with admission to the hospital on day zero for infusion of stem cells. No adverse event occurred in any patient on the day or evening of chemotherapy or required early admission.
The institution managed to save an average estimated cost of over $2,000 per patient with the implementation of the mixed model. When comparing the cost of the chemotherapy drug, melphalan, from the year before and the year after the implementation of the mixed model, the total annual cost saving was about $90,000 or 53 percent of the previous year’s expenditure.
“Although administration of chemotherapy prior to autologous stem cell transplantation in the outpatient setting has been reported as safe and cost-effective, many limitations exist with previously reported methods of transitioning out of the hospital ward,” researchers noted. “Specifically, lack of a caregiver and distance from treatment facility are key factors particularly in rural settings.”
Such limitations prevented institutions from transitioning the transplant process, or even portions of it, to the outpatient setting despite the known benefits, they added.