The importance of lowering the costs of stem cell transplantation in developing countries

Abstract

The effectiveness and efficiency of health care systems can be assessed by economic evaluation, comparing the costs and outcomes of alternative interventions. Direct costs include accommodation, nursing, physicians' fees, diagnostic tests and treatment. Indirect costs derive from the loss of a persons ability to use life in a productive way e.g. employment. In cost-effectiveness analyses, cost is the numerator and effectiveness (related to health outcomes) is the denominator. The unit of measurement of effectiveness is usually years of life saved. Cost utility analyses require a preference-based measurement of health-related quality of life (HRQL) to allow the calculation of utility scores for health states and so the adjustment of effectiveness for quality. Typically, this allows the calculation of quality-adjusted life years (QALYs). A review of published reports, to be presented in detail, yields the following summation. The greater cost of stem cell harvest from peripheral blood is more than offset by the reduced costs associated with a shorter hospital stay. Transplants early in first remission cost less than those undertaken at later points in disease evolution/treatment experience. Changing the primary locus of care from inpatient to outpatient may result in notable cost savings but can produce cost-shifting (from inpatient to outpatient). Nevertheless, in selected patient, the use of non-myeloablative transplants may offer a cost-effective option, especially in the developing country context.

Bloodless (transfusion-free) hematopoietic stem cell transplants: the Mexican experience

“…5,[2][3][4][6][7][8][9][10][11][12] The possibility now exists to perform transplants entirely on an outpatient basis, 5 making them available to a larger number of patients, 5 an issue that is critical in developing countries. [17][18][19] We have shown that by using the simplified methods previously described, 5,2-4,6-12 and without compromising the efficacy of treatment for hematological malignancies, costs can be substantially lowered: autologous and allogeneic PBSC-T can be performed at median costs of 7500 and 18000 USD, 5,2-4,6-12 respectively, figures substantially lower than those described for conventional PBSC transplantation.…”

Hematopoietic stem cell transplants for chronic myeloid leukemia in Europe—Impact of cost considerations

“…It confirms and extends previous observations. 1,7,8,13 However, the data show an additional and novel finding. Transplant rates for chronic myeloid leukemia followed the same pattern as for acute myeloid leukemia until 1999.…”

“…19 When imatinib appeared to replace the high cost procedure HSCT, an even greater drop in transplant rates could have been expected in economically less advantaged countries. 7 This was not the case. The present data cannot give a definitive answer but it can provide some clues.…”

“…[1][2][3][4] Still, HSCT is a high cost procedure and can present a financial challenge for patients and health-care systems in any country. [5][6][7] The impact of the economic strength of individual countries on HSCT has been reported earlier in detail by the European Group for Blood and Marrow Transplantation (EBMT). 8,9 It explained the differences in numbers of transplants between Eastern and Western European countries.…”

Significance of one human leukocyte antigen mismatch on outcome of nonmyeloablative allogeneic stem cell transplantation from related donors using the Mexican schedule

“…[3][4][5][6][7] In 1999, we started a prospective study of nonmyeloablative stem cell transplantation (NST) 8 using a conditioning regimen, which employs busulfan, fludarabine and cyclophosphamide. [9][10] The method has been found to be useful to allograft individuals with different diseases and is endowed with several features, which make it attractive for use in developing countries: it is considerably cheaper than conventional allografting, 11,12 can be conducted on an outpatient basis and without special areas within a hospital, [8][9][10] the transfusion requirements are very low, 13 the complication of cytomegalovirus (CMV) disease is very infrequent 14,15 and the number of apheresis procedures in the donor can be reduced in order to obtain enough hematopoietic stem cells. 10 As a result of these features, allogeneic hematopoietic stem cell transplantation can be offered now to more patients as a therapeutic option, this observation being critical for individuals living in countries with limited resources; the fact that over twothirds of the inhabitants of the world live in developing countries should not be underestimated.…”