Autologous hematopoietic stem cell transplantation (auto-HCT) is a complex procedure that can be performed in both inpatient (IP) and outpatient (OP) care settings. We examined reimbursement, service utilization, and patient financial responsibility among Medicare beneficiaries with multiple myeloma who underwent auto-HCT in the IP and OP settings using a merged dataset of the Center for International Blood and Marrow Transplant Research observational database and Centers for Medicare & Medicaid Services Medicare administrative claims data. Selection criteria included first auto-HCT, time from diagnosis to auto-HCT <18 months, and continuous enrollment in Medicare Parts A and B for 30 days before HCT index claims and 100 days post-HCT or until death. Total reimbursement and patient responsibility were adjusted for patient and disease characteristics using a weighted generalized linear model. The final cohort comprised 1640 patients, 1445 (88%) who received IP-HCT and 195 (12%) who received OP-HCT. The adjusted total mean reimbursement was higher for IP-HCT compared with OP-HCT ($82,368 [95% CI, $77,643 to $87,381] versus $46,824 [95% CI, $43,567-$50,325]; P < .0001). Adjusted total mean patient responsibility was $4736 for IP-HCT (95% CI, $4731 to $5133) and $6944 for OP-HCT (95% CI, $6296 to $7658) (P < .0001). Within 100 days post-HCT, 107 of the 195 OP-HCT recipients (55%) had at least 1 subsequent admission, compared with 348 of the 1445 IP-HCT recipients (24%). Reimbursement, service utilization, and financial responsibility varied by HCT setting. As the number of Medicare beneficiaries who undergo auto-HCT increases, coverage policy needs to consider how location of services leads to variations in the financial burden for both hospital systems and patients.

中文翻译：

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多发性骨髓瘤的Medicare受益人在住院和门诊接受自体造血细胞移植的医疗保健报销，服务利用和结果。

自体造血干细胞移植（auto-HCT）是一个复杂的过程，可以在住院（IP）和门诊（OP）护理环境中进行。我们使用国际血液和骨髓移植中心研究观察数据库与Medicare＆Medicaid中心的合并数据集，对在IP和OP设置中进行了自动HCT的多发性骨髓瘤的Medicare受益人之间的报销，服务利用和患者的财务责任进行了研究服务Medicare行政索赔数据。选择标准包括首次自动HCT，从诊断到自动HCT <18个月的时间，以及在HCT指数索取之前30天，HCT后100天或直至死亡之前连续参加Medicare Part A和B的时间。使用加权广义线性模型针对患者和疾病特征调整总报销和患者责任。最终队列包括1640例患者，接受IP-HCT的1445例（88％）和接受OP-HCT的195例（12％）。与OP-HCT相比，IP-HCT的调整后平均总报销要高（$ 82,368 [95％CI，$ 77,643至$ 87,381]与$ 46,824 [95％CI，$ 43,567- $ 50,325]； P <.0001）。IP-HCT的调整后平均总患者责任费为$ 4736（95％CI，$ 4731至$ 5133）和OP-HCT的调整后平均患者责任为$ 6944（95％CI，$ 6296至$ 7658）（P <.0001）在HCT后100天内，195名OP-HCT接受者中有107名（55％）至少有1次随后入院，而1445名IP-HCT接受者中有348名（24％）。报销，服务使用和财务责任因HCT设置而异。