Impact of payment source, referral site, and place of residence on outcomes after allogeneic transplantation in Mexico

Table 1 Baseline characteristics of 287 patients who received an allogeneic hematopoietic cell transplant

Variable		n	%
Sex	Male	168	58.6
	Female	119	41.5
Age	Median (years)	35	(16-79)
Country of origin	Mexico	270	94
	Other	17	6
State of origin	Nuevo Leon	123	42.9
	Other	164	57.1
Institution	Referral	165	57.5
	Local	122	42.5
Diagnosis	AML	77	26.8
	ALL	76	26.4
	AA	36	12.5
	NHL	29	10.1
	MDN	25	8.7
	HL	17	5.9
	CML	10	3.4
	CMML	6	2.1
	PMF	4	1.4
	CLL	4	1.4
	MM	3	1
Donor	Matched sibling	111	38.7
	Haploidentical	176	61.3
DRI	Non-malignant	36	12.6
	Intermediate	117	40.8
	High	100	34.8
	Very high	27	9.4
HCT-CI	Median	0	(0-5)
Treatment lines	Median	2	(0-6)
Payment source	Out-of-pocket	139	48.4
	Private insurance	75	26.1
	Universal coverage	73	25.4

DRI: Disease risk index; HCT-CI: Hematopoietic cell comorbidity index; AML: Acute myeloid leukemia; AA: Aplastic anemia; NHL: Non Hodgkin lymphoma; MDN: Myeldysplastic neoplasm; HL: Hodgkin lymphoma; CML: Chronic myeloid leukemia; CMML: Chronic myelomonocytic leukemia; MF: Myelofibrosis; CLL: Chronic lymphocytic leukemia; MM: Multiple myeloma.

Table 2 Cox proportional hazards regression analysis of overall survival

		HR	95%CI	P value
Univariate analysis
Age	Continuous	1	0.99-1.01	0.77
Sex	Female	1	0.71-1.4	0.98
DRI	Benign	0.66	0.36-1.19	0.02
	Low	0.15	0.02-1.08
	Intermediate	0.66	0.46-0.94
Treatment lines	Continuous	1.13	0.99-1.28	0.06
HCT-CI	Continuous	1.1	0.87-1.3	0.56
Place of residence	Out of state	0.94	0.67-1.31	0.7
Reference	Non-local	0.99	0.71-1.38	0.95
Coverage	Universal	0.76	0.51-1.13	0.02
	Private	0.55	0.35-0.86
Donor	Haploidentical	1.48	1.03-2.1	0.03
Conditioning	NMA	0.94	0.53-1.67	0.92
	RIC	1.1	0.73-1.53
GVHD prophylaxis	PTCy	1.6	0.89-3.01	0.01
Multivariate analysis
DRI	Benign	0.64	0.3-1.37	0.25
	Low	0.15	0.02-1.12	0.06
	Intermediate	0.57	0.32-1	0.05
	High	0.9	0.52-1.58	0.72
Coverage	Federal	0.86	0.58-1.29	0.46
	Private	0.49	0.31-0.77	0.002
Donor	Haploidentical	0.93	0.56-1.53	0.78
GVDH prophylaxis	PTCy	1.64	0.89-3	0.11

DRI: Disease risk index; HCT-CI: Hematopoietic cell comorbidity index: GVHD: GRAFT versus host disease; NMA: Non-myeloablative; PTCy: Post-transplant cyclophosphamide.

Table 3 Characteristics and outcomes of 287 patients who underwent allogeneic hematopoietic cell transplantation according to healthcare coverage and payment method

Variable		OOP		Universal		Private		P value
		n = 139	100%	n = 73	100%	n = 75	100%
Sex	Male	81	58.3	41	56.2	46	61.3	0.81
	Female	58	41.7	32	43.8	29	38.7
Age	Median (years)	35	(15-80)	29	(16-65)	43	(15-67)	< 0.001
Diagnosis	AML	37	26.6	15	20.5	25	33.3	0.03
	ALL	39	28.1	25	34.2	12	16
	AA	20	14.4	10	13.7	6	8
	NHL	8	5.8	10	13.7	11	14.7
	MDN	10	7.2	4	5.5	11	14.7
	HL	9	6.5	4	5.5	4	5.3
	CML	7	5	3	4.1	0	0
	CMML	3	2.2	1	1.4	2	2.7
	PMF	3	2.2	0	0	1	1.3
	CLL	3	2.2	1	1.4	0	0
	MM	0	0	0	0	3	4
Residence	In state	46	33.1	41	56.2	36	48	0.003
	Out of state	93	66.1	32	43.8	39	52
Institution	Local	38	27.3	45	61.6	39	52
	Referral	101	72.7	28	38.4	36	48	< 0.001
Donor	Identical	51	36.7	29	39.7	31	41.3	0.78
	Haploidentical	88	63.3	44	60.3	44	58.7
Treatment lines	Median	2	(0-6)	2	(0-5)	1	(0-5)	0.62
DRI	Non-malignant	20	14.4	10	13.7	6	8	0.22
	Low	3	2.2	3	4.1	1	1.3
	Intermediate	56	40.3	36	49.3	25	33.3
	High	47	33.8	18	24.7	35	46.7
	Very high	13	9.4	6	8.2	8	10.7
HCT-CI	Median	0	(0-4)	0	(0-2)	1	(0-5)	0.08
Conditioning	MAC	57	41	51	69.8	35	46.7	0.001
	RIC	62	44.6	14	19.2	32	42.7
	NMA	20	14.4	8	11	8	10.7
CD34	Median	9	(1-16)	9	(2.4-19)	8	(1.8-23.7)	0.95
GVHD prophylaxis	PTCy	109	78.4	48	65.8	63	84	0.03
	CNI + MTX	30	21.6	25	34.2	12	16
Recovery	ANC	15	(10-24)	14	(10-22)	15	(10-48)	0.66
	Platelet	15	(10-100)	14.5	(10-24)	15	(10-44)	0.83
Graft failure		17	13.1	13	18.3	8	12.2	0.5
aGVHD	Grades 1-2	46	37.1	23	38.3	23	31.9	0.7
	Grades 3-4	14	11.3	8	13.3	6	8.3
cGVHD	Mild	14	14.9	11	19.6	15	23.8	0.09
	Moderate	13	13.8	13	23.2	13	20.6
	Severe	3	3.2	6	10.7	5	7.9
Early mortality	30 d	13	9.4	5	6.8	3	4	0.35
	60 d	24	17.3	7	9.6	6	8	0.12

DRI: Disease risk index; HCT-CI: Hematopoietic cell comorbidity index; GVHD: Graft versus host disease; AML: Acute myeloid leukemia; AA: Aplastic anemia; NHL: Non Hodgkin lymphoma; MDN: Myeldysplastic neoplasm; HL: Hodgkin lymphoma; CML: Chronic myeloid leukemia; CMML: Chronic myelomonocytic leukemia; MF: Myelofibrosis; CLL: Chronic lymphocytic leukemia; MM: Multiple myeloma; MAC: Myeloablative conditioning; CNI: Calcineurin inhibitor; MTX: Methotrexate; ANC: Absolute neutrophil recovery; PTCy: Post-transplant cyclophosphamide.