Yuzhou Liu, Hedong Han, Gunjan Shah, Sergio Giralt, C. Ola Landgren, Jia He, Alexander M. Lesokhin

Autologous hematopoietic stem cell transplantation (AHCT) is the standard of care for eligible multiple myeloma (MM) patients. We aim to explore disparities in hospital cost and in-hospital mortality among MM patients who received AHCT. Data were obtained from the Nationwide Inpatient Sample (NIS) database from 2005 to 2014. International classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) diagnosis and procedure codes were used to identify patients. Hospitals were divided into quintiles according to the weighted volume of AHCT performed for patients with multiple myeloma. Multiple imputation with chained equation was used for missing data. Linear trend analysis of age-and-gender-adjusted mortality, as well as inflation-adjusted hospital cost, was performed. Univariate regression screening followed by stepwise multivariate regression was performed for dependent variables including mortality and inflation-adjusted hospital cost. Identified significant predictors underwent sensitivity analyses. Overall age- and gender- adjusted mortality rate and inflation-adjusted hospital costs decreased between 2005 and 2014. However, tremendous nationwide variability exists. Patients who received an AHCT at very low volume hospitals (Q1) had significantly higher in-hospital mortality. Both geographic location and hospital type had impact on age-and gender- adjusted mortality rates and inflation-adjusted hospital cost. Despite overall improvement in mortality and decreased cost of AHCT for MM patients, nationwide variability in care exists. Further study can identify correctable factors that contribute to the identified correlation.