US Regional Difference in Hospitalization Cost for Autologous Stem Cell Transplantation in Multiple Myeloma Patients: A Nationwide 10-Year Analysis from 2005 to 2014

Abstract

Background: Tremendous improvement of multiple myeloma (MM) care has been made in the past 10 years. However, limited real-word data is available regarding regional difference of hospitalization cost for autologous stem cell transplantation (AUTO-SCT) in MM.Methods: The Nationwide Inpatient Sample (NIS) is a validated database of discharges from a representative sampling of U.S. hospitals excluding rehab facilities and federal hospitals. Using the NIS, we identified adult patients hospitalized with ICD-9 codes for AUTO-SCT and MM from 2005 to 2014. We used trend analysis to evaluate hospitalization cost over the study period. All US hospitals in the NIS database were divided by 4 regions: Northeast(NE), Midwest(MW), South (S) and West (W). We used multivariate regression to determine associations between hospitalization cost and hospital region among patients with MM undergoing AUTO-SCT, adjusting year of admission, demographics (gender, race, age), socioeconomic variables (income, insurance), geography (facility location), institution type (facility ownership, teaching hospital status), comorbidity (Charlson comorbid score), inflation rate and length of hospitalization. We used logistic regression to determine associations between hospitalization mortality and hospital region, adjusting the same factors as above excluding length of hospitalization and inflation rate.Results: We identified 8183 patients in the NIS database, which was equal to an estimated 39,971 nationwide admissions for AUTO-SCT for MM from 2005 to 2014. Patients admitted to hospitals in South region were more likely to have an annual household income less than 39,000 (p<0.01). Patients admitted to hospitals in West region were more likely to be insured (p<0.01). Otherwise, no statistical difference was found among the hospitals from the four regions in terms of age, gender, race, comorbidity, length of stay and crude mortality. Using trend analysis, we found that the overall hospitalization cost of AUTO-SCT corrected for inflation decreased during the study period (Figure 1). When compared with hospitals in Northeast, Midwest and West region individually, hospitals in South region are associated with significantly lower hospitalization cost (P<0.001 for all three comparisons). No other significant association was found among hospitals in other regions. No statistically significant association between hospitalization mortality and hospital region was identified.Conclusion: Nationwide, inflation-adjusted costs for AUTO-SCT for MM have decreased over the past decade. However, significant regional cost differences do exist. US hospitals in South region cost significantly less during hospitalization of AUTO-SCT for MM. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.