Abstract
Abstract 2079 Background:Peripheral blood stem cell transplantations (PBSCT) are very expensive life-saving medical procedures carried out in patients with hematological disease. The current tariffs are expected to be too low due to developments in the treatment protocols. A revision of the tariffs is urgently necessary. We calculated the daily practice cost of PBSCT for treating hematological diseases in Dutch practice, to provide a proper basis for revising hospital budgets. Patients and methods:From three Dutch university hospitals, we randomly selected 191 who underwent an autologous (auto) or allogeneic (allo) PBSCT in 2008 or 2009. The alloPBSCT were subcategorized into sibling, matched unrelated donor (MUD) and unrelated cord blood (UCB). We obtained data from hospital registrations to study all treatment related activities. Unit prices were based both on real costs and tariffs (base year 2010). Thereafter, the average costs per patient per PBSCT and per period were calculated. The total cost included the selection and harvesting, transplantation and 1-year follow-up. Results:The average cost per patient of autoPBSCT were € 45,670. The cost of sibling alloPBSCT were € 101,919. The average cost of transplantations from an unrelated donor was much higher: € 171,478 for MUD and € 254,689 for UCB alloPBSCT. Hospital days, laboratory procedures and donor search were the largest cost components and mainly responsible for differences between the four types of PBSCT. None of the patient characteristics were correlated with average cost. The costs calculated in this study are above current reimbursement. The difference is significant (p=0.043) and depending on the type of PBSCT, the shortfall varied between 2% and 100%. Conclusion:Average cost of AutoSCT and alloSCT lay above current reimbursement levels. Appropriate financing is necessary to guarantee the continuation of PBSCT in Dutch patients according to current indications. The costs calculated in this study provide reliable input for economic evaluations and cost-effectiveness studies.Phase 1Phase 2Phase 3TotalSelection/ harvestingTransplanta- tionFollow-up (1-year)autoSCT (N=68)Inpatient visits6.40814.8692.143Daycare1280326Outpatient visits479272.422Intensive care visits000Activities2.8582.0486.126Medication1.3422.386362Bloodproducts7201.7941.230Total autoSCT11.93521.12412.60945.668alloSCT-sib (N=59)Inpatient visits10.16914.85813.887Daycare43628809Outpatient visits809415.125Intensive care visits37802.387HLA typing9.96800Activities5.8364.69114.139Medication1.6614.1715.469Bloodproducts2.2231.1053.733Total alloSCT-sib31.48024.89445.549101.923alloSCT-MUD (N=43)Inpatient visits12.61013.68833.370Daycare2350567Outpatient visits882425.553Intensive care visits1326575.333Donorsearch30.45600HLA typing9.96800Activities5.1543.45819.020Medication2.7788.6888.640Bloodproducts2.6612.0485.542Total alloSCT-MUD64.87628.58178.025171.482alloSCT-UCB (N=21)Inpatient visits10.00230.48034.598Daycare39502.300Outpatient visits869217.580Intensive care visits02.4006.838Donorsearch30.45600HLA typing9.96800Activities7.40012.69157.074Medication3.9464.59613.762Bloodproducts2.3626.08910.863Total alloSCT-UCB65.39856.277133.015254.690 Disclosures:No relevant conflicts of interest to declare.
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