Groot M T, van Agthoven M, Löwenberg B, Willemze R, Uyl-de Groot C A
Institute for Medical Technology Assessment, Erasmus Medisch Centrum, Postbus 1738, 3000 DR Rotterdam.
Ned Tijdschr Geneeskd. 2004 Mar 6;148(10):480-4.
To estimate the real costs of allogeneic haematopoetic stem-cell transplantation and to compare these with the historically determined budgets that are made available for this purpose ([symbol: see text] 70,038 for genetically related donors and [symbol: see text] 76,826 for unrelated donors).
Cost analysis.
In the period 1994-1999, the direct medical costs (price level of 1998) of bone-marrow transplantation from related donors (BMT), stem-cell transplantation from unrelated donors (VUD-SCT) and allogeneic peripheral-blood stem-cell transplantation (PBSCT) from related donors were determined on the basis of data on adult patients with either acute myeloid leukaemia (n = 66) or acute lymphocytic leukaemia (n = 31). First, the medical resource use by these patients was determined and multiplied by the unit costs of each of the items. Second, a structural programme for allogeneic stem-cell transplantation brings along costs that are not evident from the registration of the medical resource use (e.g., the costs of pretransplantation screening and the selection of the donor). The costs of these items were calculated by taking inventory in the hospitals and assessed by experts.
The average costs per transplanted patient were [symbol: see text] 98,334 (BMT), [symbol: see text] 151,754 (VUD-SCT) and [symbol: see text] 98,977 (PBSCT) during the first two years after transplantation. The greater part of the costs was incurred in the transplantation phase. In VUD-SCT, one-third of the total cost was due to the costs of finding a suitable donor.
The current budget for allogeneic stem-cell transplantation is insufficient to perform the transplantations adequately. Periodic evaluation of the budgets for complicated procedures based on cost analyses has added value for the evaluation of the development of these procedures in time and can thereby contribute to the quality and continuity of care.
估算异基因造血干细胞移植的实际成本，并将其与为此目的制定的历史预算进行比较（有血缘关系供者为70,038[货币符号，原文未明确]，无血缘关系供者为76,826[货币符号，原文未明确]）。
成本分析。
在1994 - 1999年期间，根据急性髓细胞白血病（n = 66）或急性淋巴细胞白血病（n = 31）成年患者的数据，确定来自有血缘关系供者的骨髓移植（BMT）、来自无血缘关系供者的干细胞移植（VUD - SCT）以及来自有血缘关系供者的异基因外周血干细胞移植（PBSCT）的直接医疗成本（1998年价格水平）。首先，确定这些患者的医疗资源使用情况，并乘以各项的单位成本。其次，异基因干细胞移植的结构性项目会带来一些从医疗资源使用记录中不明显的成本（例如，移植前筛查和供者选择的成本）。这些项目的成本通过在医院盘点计算得出，并由专家评估。
移植后前两年，每位移植患者的平均成本分别为98,334[货币符号，原文未明确]（BMT）、151,754[货币符号，原文未明确]（VUD - SCT）和98,977[货币符号，原文未明确]（PBSCT）。大部分成本发生在移植阶段。在VUD - SCT中，总成本的三分之一归因于寻找合适供者的成本。
目前异基因干细胞移植的预算不足以充分开展移植手术。基于成本分析对复杂手术预算进行定期评估，对于及时评估这些手术的发展具有附加价值，从而有助于提高医疗质量和保障医疗的连续性。
