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

• Published in: PloS one 2021-08, Vol.16 (8), p.e0254135-e0254135
• Main Authors: González, Marino J, Urizar, Elena, Urtaran-Laresgoiti, Maider, Nuño-Solinís, Roberto, Lázaro-Pérez, Esther, Vázquez, Lourdes, Pascual-Cascón, Maria Jesús, Solano, Carlos, Kwon, Mi, Gallego, Cristina, Fernández-Avilés, Francesc
• Format: Article
• Language: English
• Subjects: Ambulatory medical care; Autografts; Biology and Life Sciences; Bone marrow; Business schools; Cell culture; Comparative analysis; Comparative studies; Costs; Disease prevention; Health care; Hematology; Hematopoietic stem cells; Hospitals; Medical care; Medicine and Health Sciences; Methods; Mortality; Nosocomial infections; Patients; Quality management; Quality of life; Research and Analysis Methods; Stem cell transplantation; Stem cells; Supervision; Survival; Systematic review; Transplantation; Transplants
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0254135

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.