Abstract
ABSTRACTBackground: Hematopoietic stem cell transplantation (HSCT) is a medically complicated therapy with a long recovery time. In Tunisia, the National Health Insurance Fund (CNAM) covers only the first year post-transplantation, after which the costs are borne by the hospital.Objective: Describe complications that can occur during the second year post-allogeneic HSCT and calculate direct costs in different groups of patients.Methods: In this pharmacoeconomic study, medical records of the second year post-allogeneic HSCT were collected. Studied variables included frequent observed complications and medical and non-medical direct costs.Results: The average total direct cost in the population during the second year post-transplantation was $11,571, 97% of which represents direct medical costs Drugs accounted for the largest share (80%) of total direct costs, dominated by the cost of antifungals (52%) and antivirals (26%) drug . Cytomegalovirus status was seen in 9.3% of patients and was associated with a seven-fold increase in direct costs (p < 0.001).In patients who developed chronic GVHD, the average direct cost was three times higher than for those who did not (p = 0.032).Conclusion: Given the importance of direct costs in the post-transplantation period a review of the hospital financing mechanism and a new convention with the CNAM is crucial.
Highlights
Hematopoietic stem cell (HSC) transplantation is a highly specialized therapy and an expensive medical procedure, which requires important medical resources.Management of complications, such as infections which can occur during the early phase of neutropenia and late-onset complications following transplantation, in particular graft-versus-host disease (GVHD) [1] and graft rejection, are responsible for increased allograft costs [2,3]
Our research focused on patients who underwent allogeneic bone marrow (BM) and peripheral stem cell (PSC) transplantation during 2012 because of the availability of data and, above all, to enable the results to be presented to the authorities in order to revise the convention budget with the Caisse Nationale d’Assurance Maladie (CNAM)
A previous study, which evaluated the factors associated with high costs after allogeneic HSC transplantation, reported that increased 1 year costs were seen for post-transplantation complications: rejection [relative hazard (RH) = 1.24, p < 0.001], acute GVHD (RH = 1.31, p < 0.001), and invasive fungal infection (RH = 1.15, p = 0.02) [7]
Summary
Hematopoietic stem cell (HSC) transplantation is a highly specialized therapy and an expensive medical procedure, which requires important medical resources. Management of complications, such as infections which can occur during the early phase of neutropenia and late-onset complications following transplantation, in particular graft-versus-host disease (GVHD) [1] and graft rejection, are responsible for increased allograft costs [2,3]. Most of them were limited to pharmacoeconomic aspects of the pre-transplantation treatment analysis, the transplantation procedure, and treatment during the first year after transplantation Those studies excluded any extra costs going beyond the latter period. Conclusion: Given the importance of direct costs in the post-transplantation period a review of the hospital financing mechanism and a new convention with the CNAM is crucial
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