Cost of hematopoietic cell transplantation for hematologic malignancies from a transplant center in a developing country

Abstract

OBJECTIVE: Hematopoietic cell transplantation is a resource-intensive procedure influenced by several cost drivers. The primary objective of this study was to compare the costs of matched-sibling (MSD), unrelated (URD), and haploidentical (Haplo) donor transplants and to identify patient- and transplant-related factors associated with higher costs. METHODS: This observational, retrospective cohort study compared the costs among human leucocyte antigen (HLA)-matched MSD, HLA-matched URD, and Haplo transplants. Patients with hematologic malignancies who underwent their first allogeneic hematopoietic cell transplantation were included. Median cost analyses were performed using a parametric lognormal survival model at 1 year. Patients who did not complete the follow-up were censored. The median follow-up was 53 months, and a total of 177 patients were included (54 MSD, 43 Haplo, and 80 URD). RESULTS: Crude 1-year costs were US$83,753 for MSD, lower than those of URD (US$122,811) and Haplo (US$148,461) (p=0.01). In the 1-year cost model, Haplo (p=0.02) and URD (p=0.01) were associated with higher costs than MSD. In multivariable analysis, Haplo (p=0.008) and URD (p=0.004) remained independently associated with higher costs. Haplo costs were not significantly different from URD costs (p=0.84). CONCLUSION: From a financial perspective, sibling transplantation remains the gold standard treatment.