Cost structure and clinical outcome of a stem cell transplantation program in a developing country: the experience in northeast Mexico.
OBJECTIVE
Hematopoietic stem cell transplantation (HSCT) in developing countries is cost-limited. Our primary goal was to determine the cost structure for the HSCT program model developed over the last decade at our public university hospital and to assess its clinical outcomes.


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
Fifty patients were evaluated over a 1-year period. The total estimated cost for an allogeneic HSCT was $12,504. The two most expensive diseases to allograft were non-Hodgkin lymphoma ($11,760 ± $2,236) for the malignant group and thalassemia ($12,915 ± $5,170) for the nonmalignant group. Acute lymphoblastic leukemia ($11,053 ± 2,817) and acute myeloblastic leukemia ($10,251 ± $1,538) were the most frequent indications for HSCT, with 11 cases each. Median out-of-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 the first year. The most expensive components were drugs and laboratory tests.


CONCLUSIONS
Applying the cost structure described, HSCT is an affordable option for hematological patients living in a developing country.
Department of Hematology, Internal Medicine Division, Dr. José E. González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México carjaime@hotmail.com.
José Carlos
JC
Jaime-Pérez
Department of Hematology, Internal Medicine Division, Dr. José E. González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México.
Alberto Carlos
AC
Heredia-Salazar
Department of Hematology, Internal Medicine Division, Dr. José E. González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México.
Olga G
OG
Cantú-Rodríguez
Department of Hematology, Internal Medicine Division, Dr. José E. González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México.
Homero
H
Gutiérrez-Aguirre
Department of Hematology, Internal Medicine Division, Dr. José E. González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México.
César Daniel
CD
Villarreal-Villarreal
Department of Hematology, Internal Medicine Division, Dr. José E. González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México.
Consuelo
C
Mancías-Guerra
Department of Hematology, Internal Medicine Division, Dr. José E. González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México.
José Luís
JL
Herrera-Garza
Department of Hematology, Internal Medicine Division, Dr. José E. González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México.
David
D
Gómez-Almaguer
D003365:Costs and Cost Analysis; D003906:Developing Countries; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000628:therapy; D008228:Lymphoma, Non-Hodgkin / Q000628:therapy; D008297:Male; D008800:Mexico; D013789:Thalassemia / Q000628:therapy; D014184:Transplantation, Homologous / Q000191:economics; D016896:Treatment Outcome
HSCT cost containment; HSCT cost structure; HSCT costs; HSCT in developing countries; Hematopoietic stem cell transplant; Out-of-pocket expenses