Cost Structure and Clinical Outcome of a Stem Cell Transplantation Program in a Developing Country: The Experience in Northeast Mexico

Background and Objective. Hematopoietic stem cell transplantation (HSCT) in developing countries is cost-limited. Our primarygoalwastodeterminethecoststructurefortheHSCT program model developed over the last decade at our public university hospital and to assess its clinical outcomes. Materials and Methods. Adults and children receiving an allogeneic hematopoietic stem cell transplant from January 2010 to February 2011 at our hematology regional reference center were included. Laboratory tests, medical procedures, chemotherapy drugs, other drugs, and hospitalization costs were scrutinized to calculate the total cost for each patient and the median cost for the procedure. Data regarding clinical evolution were incorporated into the analysis. Physician fees are not charged at the institution and therefore were not included. Results. Fiftypatientswereevaluatedovera1-yearperiod.The total estimated cost for an allogeneic HSCT was $12,504.The two most expensive diseases to allograft were non-Hodgkin lymphoma ($11,760 6 $2,236) for the malignant group and thalassemia ($12,915 6 $5,170) for the nonmalignant group. Acute lymphoblastic leukemia ($11,053 6 2,817) and acute myeloblastic leukemia ($10,251 6 $1,538) were the most frequentindicationsforHSCT,with11caseseach.Medianoutof-pocket expenses were $1,605, and 1-year follow-up costs amounted to $1,640, adding up to a total cost of $15,749 for thefirstyear.Themostexpensivecomponentsweredrugsand laboratory tests. Conclusion. Applying the cost structure described, HSCT is an affordable option for hematological patients living in a developing country.The Oncologist 2015;20:386–392 Implications for Practice: This article describes in detail the strategy for performing hematologic transplantation at a public institution caring for uninsured patients applying an in-house cost-efficiency model that maximizes scarce financial resources. It provides individual costs for standard drugs and therapeutic, as well as laboratory, procedures used during the intervention. The results are important because they convey the message that this type of transplant can be made at affordable costs for diverse hematologic diseases without requiring expensive infrastructure,exemplifying how good clinical results, similar to those in advanced institutions in developed countries, can be reached with adequate planning and an experienced team.