Cost of Treatment of Multiple Myeloma in a Public Sector Tertiary Care Hospital of North India

Abstract

Multiple myeloma (MM) is a neoplastic disorder, which accounts for 13% of all hematological malignancies globally. While, conventional chemotherapy used to be the mainstay treatment for the disease, the landscape of treatment witnessed a paradigm shift with the introduction of high-dose chemotherapy and autologous stem cell transplant (ASCT). In this paper, we present a cost analysis of various services provided to multiple myeloma patients, using either of the two modalities of treatments i.e. conventional chemotherapy or ASCT. Bottom-up costing methodology was used to collect data on all health system resources, i.e. capital or recurrent, which were used to provide various services to MM patients. Capital costs were annualized for their useful life using a discount rate of 5%. Out of pocket expenditure on treatment was also ascertained. Cost was assessed for various services, including outpatient consultation, bed day hospitalization in general ward, high dependency unit intensive care setting and bone marrow transplant unit. Unit costs were calculated from both health system and patient perspective. The overall cost per patient for ASCT (including high dose chemotherapy) and conventional chemotherapy from societal perspective was INR 395,527 (USD 6085) and INR 62,785 (USD 966) respectively. Estimates on cost from our study could be used for planning health services, and evaluating cost effectiveness of different modalities of care for multiple myeloma.

Real-world cost-effectiveness of pan-genotypic Sofosbuvir-Velpatasvir combination versus genotype dependent directly acting anti-viral drugs for treatment of hepatitis C patients in the universal coverage scheme of Punjab state in India

“…The quality of life data as well as cost estimates of hospitalisation for HCV patients were again based on primary data collected from a local setting in north India. All estimates of health system cost were derived from studies conducted in health facilities of 3 north Indian states [24–27]. Similarly, data on out-of-pocket expenditure was derived based on analysis of a nationally representative household survey [30].…”

“…Similarly, these costs for IPD were ₹ 6347 (US $ 90), ₹ 7597 (US $ 108) and ₹ 18693 (US $ 267) [24–26]. The tertiary sector costs for IPD included both the cost of medicine ward [27] as well as the intensive care unit (ICU) costs. The costs of diagnostic tests were estimated from the provider payment rates of Punjab government contracted laboratories [12].…”

Sub-national health accounts: Experience from Punjab State in India

“…For instance, funds going to public hospitals through DDGs are divided into inputs, whereas the facility performs various functions using those inputs, which are of interest in SHA exercise. In order to apportion shared expenditures for various functions, we drew cost ratios from recently published literature on costing of public health service delivery undertaken northern states including Punjab [20][21][22][23][24][25][26][27].…”

Establishing reference costs for the health benefit packages under universal health coverage in India: cost of health services in India (CHSI) protocol

“…3 While there is relatively significant data on out-ofpocket expenditure in India, there are a limited number of studies on the health system cost. 4 5 Published cost studies include costing of surgical procedures, 6 disease or condition-specific treatments [7][8][9] and public healthcare facility costs. [10][11][12] These are not comprehensive and do not systematically cover all healthcare services and healthcare providers-most significantly the absence of the private sector.…”