PCN72 THE REAL COST OF BONE MARROW TRANSPLANTATION: AN APPLICATION USING TIME-DRIVEN ACTIVITY-BASED COSTING IN BRAZIL

Abstract

To report preliminary results of a time-drive activity-based costing (TDABC) application to evaluate costs of the entire cycle of care of patients submitted to bone marrow transplantation (BMT) and to identify improvement opportunities for transplant reimbursement policies. Based on the TDABC method, 15 patients were monitored at pre-BMT phase; 28 patients during the hospitalization; and 7 patients after the hospital discharge until day 100 (post-BMT). Analysis was stratified into three macro stages: cost per procedure phase, the composition of cost per resource, and a comparison between total cost and reimbursement by the Brazilian healthcare system (SUS). Results were converted to international dollars by the Purchasing Power Parity rate in 2019 The median time of hospitalization of 28 patients submitted to BMT was 64 days (33 - 172), wherein 8 died during this period. The median total cost per patient was $212,390 [IQR $92,383 - $443,430]. Pre-transplant phase median cost was $1,472 [IQR $863 - $2,970], being exams the most representative cost (52%). The hospitalization median cost was $188,108 (IQR $74,456 - $347,913]; medications and materials (34%) and fixed costs (26%) were the most expensive resources consumed. At post-BMT period, the median cost was $22,810 [IQR $17,063 - $92,547]; materials and medications, and physician consulting time representing 52% of this amount. Comparing SUS total cost reimbursed ($31,260), which is a fixed value and comprises the three phases of BMT, there is deficit of $181,130. The differences among the three macro stages of transplantation provide a better understanding of how patients consume resources throughout the entire care cycle and the actual cost of each stage. It also motivates the review of health reimbursement policies considering the patient's condition to the detriment of the current SUS single payment model for BMT.