BMT CTN 1102 clinical trial offers insights into out-of-pocket costs and financial hardship
Patients who need an allogeneic blood or marrow transplant (BMT) have many out-of-pocket costs—from copays for medical services and prescription medicines to housing close to the transplant center. But are those costs different than those for patients who receive a treatment other than BMT for the same disease?
The Blood and Marrow Transplant Clinical Trials Network (BMT CTN) 1102 study offered an opportunity to find out.
What the researchers investigated
The BMT CTN 1102 clinical trial studied outcomes for older patients (50 to 75 years old) with intermediate- to high-risk myelodysplastic syndromes (MDS). It compared patients who had an allogeneic BMT using an available, well-matched family member or unrelated donor to patients that had treatment other than BMT.
At the same time, the investigators conducted an economic evaluation to understand the financial impact of treatment. Patients could opt-in to the financial study when they enrolled on the clinical trial.
Patients who opted in completed a cost diary survey at 1, 7 and 19 months after enrollment. The survey captured detail on out-of-pocket (OOP) costs for:
- Outpatient services
- Prescription medicines
- Accommodations, like hotel stays, made for health care purposes
The survey also asked questions about financial hardship such as:
- Using reserve funds, like savings, stocks or selling real estate
- Borrowing money to pay for care
- Developing debt due to care
The investigators evaluated the participants’ responses based on whether the patient had a transplant or did not have a transplant.
What the study found
Patients with MDS who received transplant had more OOP costs overall compared to patients on the clinical trial who didn’t receive transplant. Total OOP costs were significantly higher at 1 month and 7 months after enrollment (average OOP costs over past 30 days, 1 month: $889 vs. $217, p=0.046; 7 months: $678 vs. $349, p=0.03; 19 months: $328 vs. $103, p=0.15). Accommodation costs were especially high for patients who had BMT, with an average of $1,084 spent at 1 month and $1,007 spent at 7 months compared to $0 for those who did not have BMT.
Patients who received BMT were also more likely to develop financial hardships, including using reserve funds, borrowing money and developing debt. They were significantly more likely to experience at least one of these financial hardships at 7 months (42% vs. 13%); p=0.04).
What this means for patients
These findings show substantial BMT-related OOP expenses for patients with intermediate- and high-risk MDS. These expenses can lead to financial hardships.
Implementing programs to provide financial navigation and assistance to patients considering transplant could help address the issue.
It’s important to consider that the number of participants in the financial evaluation was small. Additional evaluation with a larger number of transplant patients can validate these findings and assess programs to address this potential barrier to transplant.