Hospital and outpatient models for Hematopoietic Stem Cell Transplantation: A systematic review of comparative studies for health outcomes, experience of care and costs

PLoS One. 2021 Aug 12;16(8):e0254135. doi: 10.1371/journal.pone.0254135. eCollection 2021.

Abstract

The number of Hematopoietic Stem Cell Transplantations has risen in the past 20 years. The practice of outpatient Hematopoietic Stem Cell Transplantation programs is increasing in an attempt to improve the quality of patient care and reduce the demand for hospital admission. A systematic review of 29 comparative studies between in-hospital and outpatient treatment of Hematopoietic Stem Cell Transplantation, with no restriction by outpatient regime was conducted. This study aims to analyse the current evidence on the effects of the outpatient model on patient-centred outcomes, comparing both in-hospital and outpatient models for autologous and allogeneic HSCT using the Triple Aim framework: health outcomes, costs and experience of care. We found evidence on improved health outcomes and quality of life, on enhanced safety and effectiveness and on reduced overall costs and hospital stays, with similar results on overall survival rates comparing both models for autologous and allogeneic patients. We also found that the outpatient Hematopoietic Stem Cell Transplantation is a safe practice as well as less costly, it requires fewer days of hospital stay both for autologous and allogeneic transplantations. Under a situation of an increasing number of transplants, rising healthcare costs and shortages of hospital capacity, incorporating outpatient models could improve the quality of care for people requiring Hematopoietic Stem Cell Transplantation programs.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Costs and Cost Analysis
  • Disease-Free Survival
  • Hematopoietic Stem Cell Transplantation / economics*
  • Hematopoietic Stem Cell Transplantation / mortality
  • Humans
  • Length of Stay / economics*
  • Models, Economic*
  • Quality of Life*
  • Survival Rate
  • Transplantation, Autologous
  • Transplantation, Homologous

Grants and funding

This research did not receive conditioning funding but has been developed as a by-product of a project funded by the pharmaceutical company Merck Sharp & Dohme Spain. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.