Costs and outcomes with once-daily versus every-six-hour intravenous busulfan in allogeneic hematopoietic cell transplantation. Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation Singhal, S. n., Kim, T. n., Jenkins, P. n., Bassett, B. n., Tierney, D. K., Rezvani, A. R. 2019


The high cost of healthcare in the United States have not been consistently associated with improved health outcomes or quality of care, necessitating a focus on value-based care. We identified busulfan dosing frequency during allogeneic hematopoietic cell transplantation (HCT) conditioning as a potential target for optimization. To improve patient convenience and to decrease the cost of busulfan-based conditioning regimens, our institution changed busulfan dose frequency from every six-hours (q6h) to once-daily (q24h). We compared costs and patient outcomes between these two dose schedules.In June 2017, our institution transitioned from q6h to q24h busulfan dosing. We compared patients receiving busulfan/cyclophosphamide conditioning regimens (BU/CY) for allogeneic HCT in the year prior to the dosing change (q6h cohort) to those in the year after the dosing change (q24h cohort). The primary outcomes were difference in cost, day +90 mortality, and day +90 relapse.Between June 1, 2016 and June 1, 2018, 104 patients (age 49, 20-63 years) received BU/CY before allogeneic HCT. Fifty-nine patients (57%) received q6h busulfan, and 45 (43%) received q24h busulfan. There were fewer men in the q24h busulfan cohort (42%) compared to the q6h busulfan cohort (64%, p=0.024), but there were no other significant differences between the groups. There was an average cost savings of $19,990 per patient per year with q24h busulfan compared to q6h busulfan, and an annual busulfan cost savings of $899,550.00. There was a significantly lower day +90 mortality in the q24h busulfan cohort compared to the q6h busulfan cohort (0% vs 10%, p=0.028). There were no significant differences in relapse at day +90 or in hospital length of stay.Intravenous busulfan dosing for allogeneic HCT conditioning is a target for improved value-based care. At our institution, patients who received q24h busulfan dosing had similar or superior outcomes compared to those receiving q6h dosing, with a reduction in average cost of $19,990 per patient per year and an overall annual reduction in busulfan costs of approximately $900,000.00. These data support the adoption of q24h intravenous busulfan dosing as a standard of care to improve value-based care in allogeneic HCT.

View details for DOI 10.1016/j.bbmt.2019.09.008

View details for PubMedID 31525492