Direct cost analysis of the second year post-allogeneic hematopoietic stem cell transplantation in the Bone Marrow Transplant Centre of Tunisia

Abstract

Background: 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.​​

Real-world study of direct medical and indirect costs and time spent in healthcare in patients with chronic graft versus host disease

“…Our present study showed that the cumulative direct medical cost of specialised healthcare during the first 3 years of follow-up in patients with moderate–severe cGVHD was approximately four- and threefold higher versus patients with non-cGVHD or mild cGVHD, respectively. Similarly, a Tunisian pharmacoeconomic study showed that the expenditure on patients with cGVHD was threefold higher versus patients with non-cGVHD [ 24 ]. A study assessing the base-case estimated costs for cord-blood transplantations reported that the presence of cGVHD was associated with direct costs of USD 2716 (EUR 2288 [adjusted for inflation for 2018]) [ 23 ].…”

“…Studies have shown that cGVHD remains a barrier to reducing the cost burden for long-term survivors after HSCT. Although a number of studies have assessed this cost burden, there are few recent studies of the burden of cGVHD following HSCT [ 21 – 24 ]. Notably, an economic study in France ( n = 134) in adults with acute leukaemia showed that patients with cGVHD required an additional 12 days of hospitalization, at a cost of EUR 765 per day [ 22 ].…”

“…Notably, an economic study in France ( n = 134) in adults with acute leukaemia showed that patients with cGVHD required an additional 12 days of hospitalization, at a cost of EUR 765 per day [ 22 ]. In a recent pharmacoeconomic analysis in Tunisia of patients who had undergone HSCT with acute and chronic leukaemia, the average direct cost of managing cGVHD was threefold higher than for those without cGVHD [USD 19,523 ( n = 13) versus 6073 ( n = 19), respectively; p = 0.032] [ 24 ]. A recent US claims study ( n = 523) reported steroid-resistant cGVHD patients spent significantly more days in healthcare and had higher healthcare resource utilisation costs, particularly inpatient costs, compared to non-cGVHD patients in the first 2 years post-HSCT [ 25 ].…”