Financial burden of national health insurance for treating patients with transfusion-dependent thalassemia in Taiwan

Ho, Wan‐Ling; Lin, Kai‐Hsin; Wang, J.-D.; Hwang, Jing‐Shiang; Chung, Chih Wen; Lin, Dong‐Tsamn; Jou, Shiann-Tarng; Lu, Meng-Yao; Chern, Jimmy P. S.

doi:10.1038/sj.bmt.1705287

Cited by 40 publications

(30 citation statements)

References 17 publications

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“…The cost of BMT is equivalent to that of a few years of noncurative supportive care. 3,11,12 The standard combination of busulfan and cyclophosphamide (BuCy) is associated with rejection rates ranging from 12% to 35%, 13,14 which prompted the addition of other engraftment-enhancing agents such as thiotepa (Tt) 15,16 or anti-thymocyte globulin (ATG) 13,[17][18][19] to busulfan-or treosulfan-containing regimens. Very long-term follow-up studies have shown that BuCy may be associated with normalization of HRQoL, no second malignancies in the absence of chronic graft-versus-host disease (cGVHD), and preservation of fertility in a significant number of patients transplanted prior to age 15 years.…”

Section: Introductionmentioning

confidence: 99%

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ATG vs thiotepa with busulfan and cyclophosphamide in matched-related bone marrow transplantation for thalassemia

et al. 2017

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Key Points• In low-risk BMT for thalassemia, ATGBuCy seems as effective as Tt-BuCy in the prevention of rejection and may decrease transplant-related mortality. received ATG-BuCy. All patients were ,15 years and had no hepatomegaly (liver #2 cm from costal margin). Actuarial overall survival in the Tt-BuCy and ATG-BuCy groups was 87% and 94% and thalassemia-free survival was 80% and 85% at a median follow-up of 37 and 17 months, respectively, with no significant differences by log-rank statistics. SubstitutingTt with ATG in the standard BuCy context seems safe and effective and may decrease transplant-related mortality. Higher fertility rates are expected for patients who received ATG-BuCy.

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Section: Introductionmentioning

confidence: 99%

“…[2][3][4] In spite of improved iron chelation therapy and safer transfusions, 5 ST remains a severe disease, particularly in developing countries, where often state-of-the-art care is not affordable and/or accessible. ST is also a major indication for blood and marrow transplantation (BMT) in children in the Indian subcontinent.…”

Section: Introductionmentioning

confidence: 99%

ATG vs thiotepa with busulfan and cyclophosphamide in matched-related bone marrow transplantation for thalassemia

et al. 2017

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“…One advantage of this study is that we used a populational health insurance claims database which covers all age groups among cancer patients. The coverage of age groups of this study is wider than published studies [9,10,16] which cover adults only. One limitation of our study is that we can not investigate the relationship between the severity of cancer and medical costs, and the dose-response relationship between the chemotherapy regimens and the severity of anemia.…”

Section: Discussionmentioning

confidence: 83%

Medical resource utilizations and economic burden in Chinese cancer patients with chemotherapy-induced anemia: A populational database study

Liu

et al. 2008

Chin. J. Cancer Res.

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Objective:Most of published studies emphasized the medical cost of treating chemotherapy-induced anemia (CIA) by using specific agents, for example, epoetin α, epoetin β, darbepoetin α or combined with red blood cell transfusions, however, the investigation of the overall medical resources utilizations and economic burden of CIA is still limited. Besides, such studies which emphasized Chinese population still lack. The aim of this study is to investigate the medical resource utilization and the economic burden of Chinese cancer patients with CIA by using a populational representative claim database. Methods: The data for this study are from the 2000-2003 Population Health Insurance Research Database (PHIRD) in Taiwan. On the basis of issuing catastrophic illness cards in the enrollment data files, a total of 26,053 beneficiaries were identified from the PHIRD, who were newly diagnosed with these four cancers in 2001 and 2002 (2001: n=12,954; 2002: n=13099). A generalized linear model (GLM) was employed for analyzing the differences of medical resource utilization and economic burden between the anemic and non-anemic groups. Results: Analyses showed that the anemic patients were significantly more likely to have longer length of hospital stay than non-anemic patients (P<0.05) across all these four cancers and in two study periods (except women breast cancer in 2002/03). As regards the health care expenditures, the average one-year total medical cost was USD$8,982 (2001/02) and USD$8,990 (2002/03) for anemic patients among these four cancers, and USD$7,769 (2001/02) and USD$7713 (2002/03) for non-anemic patients (P<0.0001).As for ambulatory costs, anemic patients' was significantly higher than non-anemic patients' for lung cancer (in 2001/02), women breast cancer (in 2001/02 and 2002/03) and the summarized data (in 2001/02). As for inpatient costs, anemic patients' was significantly higher than non-anemic patients' for gastric cancer (in 2002/03), colon and rectal cancer (in 2001/02 and 2002/03), lung cancer (in 2001/02 and 2002/03), women breast cancer (in 2001/02) and the summarized data (in 2001/02 and 2002/03).Conclusion: This study is the first study to demonstrate that cancer patients who receive chemotherapy and with anemia utilize more medical resources and have heavier economic burden among Chinese cancer patients. Although the Population Health Insurance Program in Taiwan was established to provide more low-burdened medical care for all cancer patients, further effort is still needed to reduce the economic burden for cancer patients who have specific complications.

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“…13,14 To our knowledge, this study is the first to suggest that the utilization of double-unit UCBT has shown promising results in teenagers with transfusion-dependent thalassemia, although the clinical effectiveness of HSCT over traditional transfusion and chelation therapy has been reported previously. 15 Notably, tolerability and safety were also acceptable in the therapeutically challenging clinical setting of our study. Phlebotomy was not routinely performed in our study, as it may stimulate the hyperplastic bone marrow after HSCT, and the residual recipient cells may also be stimulated.…”

Section: Discussionmentioning

confidence: 83%

Transplantation of unrelated donor umbilical cord blood utilizing double-unit grafts for five teenagers with transfusion-dependent thalassemia

et al. 2007

Bone Marrow Transplant

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To augment graft cell dose, we evaluated the safety of the combined transplantation of two partially HLA-matched umbilical cord blood (UCB) units. Five patients with transfusion-dependent thalassemia, median age 11.1 years (range 10-13.1), received 2 UCB units after myeloablative conditioning. Cord blood units were a 4/6-HLA-match or better with the recipient, and contained a minimum combined pre-freeze CD34 cell dose of 3.0 Â 10 5 /kg. All patients engrafted at a median of 15 days (range 12-19). Four patients with durable trilineage engraftment showed acute grade I-III GVHD; none developed extensive chronic GVHD until the date of last contact. The median times to red blood cell transfusion independence and platelet engraftment were 32 and 49 days after transplant, respectively. With a median follow-up of 18.5 months (range 11-32), four patients transplanted with UCB from two different partially HLA-matched donors were transfusion-independent. Therefore, transfusion of two partially HLA-matched UCB units is safe, and may overcome the cell-dose barrier that limits the use of UCB in longterm recipients of multiple transfusions for thalassemia.

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Financial burden of national health insurance for treating patients with transfusion-dependent thalassemia in Taiwan

Cited by 40 publications

References 17 publications

ATG vs thiotepa with busulfan and cyclophosphamide in matched-related bone marrow transplantation for thalassemia

ATG vs thiotepa with busulfan and cyclophosphamide in matched-related bone marrow transplantation for thalassemia

Medical resource utilizations and economic burden in Chinese cancer patients with chemotherapy-induced anemia: A populational database study

Transplantation of unrelated donor umbilical cord blood utilizing double-unit grafts for five teenagers with transfusion-dependent thalassemia

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