Systematic Review of Economic Evaluations in allogeneic Hematopoietic Stem Cell Transplantation


      The objective of this literature review was to explore the existing evidences regarding cost-effectiveness of allogeneic hematopoietic stem cell transplantation (AHSCT) in hematologic cancers (HCs).


      A systematic literature review was performed using the PICO method: Population consisted of patients suffering from HCs; Intervention and Comparators were AHSCT compared to different types of AHSCT or standard therapies and Outcomes were incremental cost-utility ratios (ICURs) and/or incremental cost-effectiveness ratios (ICERs). The literature search was performed with the NHS EED filters using electronic databases from 1948 until August 2014.


      The literature review allowed retrieving 5,805 studies of which 13 fulfilled the eligibility criteria. Three studies included economic analysis on acute myeloid leukemia (AML), two on acute lymphoid leukemia (ALL), five on acute leukemias, three on chronic myeloid leukemia (CML) and one on myelodysplastic syndromes. Nine were cost-effectiveness analyses and four were cost-utility analyses. Five studies used a Markov model. The largest proportion of the studies compared AHSCT to standard chemotherapy (SC) (n=5), followed by imatinib (n=2) and various other comparators (n=6). The time horizon varied from 1 year to lifetime. All studies used a health care system perspective. In AML and ALL, ICERs ranged from dominant to (2014US)$154,597/LYG compared to SC. In Philadelphia-positive (Ph+) CML, ICERs for imatinib ranged from dominant to (2014US)$127,013/QALY compared to AHSCT.


      Most of analyzed studies suggest that AHSCT is cost-effective in AML and ALL compared to SC, but not in Ph+CML when compared to imatinib, despite a wide cost-effectiveness ratios range. This is consistent with current clinical practice in Ph+CML, where tyrosine kinase inhibitors, like imatinib, have replaced AHSCT for first-line therapy. Despite the high level of heterogeneity among selected studies, this review provides a comprehensive overview of the cost-effectiveness of AHSCT in HCs and could serve in the realization of future economic evaluations.