Gratwohl, AloisSureda, AnnaBaldomero, HelenGratwohl, MichaelDreger, PeterKröger, NicolausLjungman, PerMcGrath, EoinMohty, MohamadNagler, ArnonRambaldi, Alessandro2021-10-192021-10-192015-11-192352-3964https://hdl.handle.net/2445/180666Hematopoietic stem cell transplantation (HSCT) is a lifesaving expensive medical procedure. Hence, more transplants are performed in more affluent countries. The impact of economic factors on patient outcome is less defined. We analyzed retrospectively a defined cohort of 102,549 patients treated with an allogeneic (N = 37,542; 37%) or autologous (N = 65,007; 63%) HSCT. They were transplanted by one of 404 HSCT centers in 25 European countries between 1999 and 2006. We searched for associations between center-specific microeconomic or country-specific macroeconomic factors and outcome. Center patient-volume and center program-duration were significantly and systematically associated with improved survival after allogeneic HSCT (HR 0·87; 0·84-0·91 per 10 patients; p < 0·0001; HR 0·90;0·85-0·90 per 10 years; p < 0·001) and autologous HSCT (HR 0·91;0·87-0·96 per 10 patients; p < 0·001; HR 0·93;0·87-0·99 per 10 years; p = 0·02). The product of Health Care Expenditures by Gross National Income/capita was significantly associated in multivariate analysis with all endpoints (R2 = 18%; for relapse free survival) after allogeneic HSCT. Data indicate that country- and center-specific economic factors are associated with distinct, significant, systematic, and clinically relevant effects on survival after HSCT. They impact on center expertise in long-term disease and complication management. It is likely that these findings apply to other forms of complex treatments.9 p.application/pdfengcc-by-nc-nd (c) Gratwohl, Alois et al., 2015http://creativecommons.org/licenses/by-nc-nd/4.0/Cèl·lules mareAvaluació de resultats (Assistència mèdica)Dret a la salutSalut públicaStem cellsOutcome assessment (Medical care)Right to health carePublic healthinfo:eu-repo/semantics/article6960902021-10-19info:eu-repo/semantics/openAccess26844291