Rivera-Franco Monica M, Leon-Rodriguez Eucario, Castro-Saldaña Haydee L
Hematology and Oncology Department, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Vasco de Quiroga 15, Belisario Dominguez Seccion XVI, Tlalpan, Mexico City, 14080, Mexico.
Current Accounts Department, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico.
Int J Hematol. 2017 Oct;106(4):573-580. doi: 10.1007/s12185-017-2278-1. Epub 2017 Jun 14.
Costs of HSCT in the United States have been widely reported, but complete information on costs in developing countries is lacking. We performed an analysis designed to assess the real, detailed costs of HSCT in Mexico. Using the database of the Current Accounts Department at our Institution, we performed a micro-costing based analysis of patients from 2010 through 2015 to obtain the overall cost of HSCT during the in-patient procedure and 2-month follow-up. One hundred five transplantations (57% autologous) were performed. The most frequent indications for transplantation were lymphomas (32%), followed by acute leukemias (22%). The most frequently used conditioning regimen was reduced BUCY 2 (38%), followed by BEAM (28%). Among post-transplant complications, acute graft-versus-host-disease was not associated with higher costs (p = 0.8). The median costs (in-patient and 2-month outpatient follow-up) for auto and allo-HSCT were 12,155 and 18,260 USD, respectively. Advances in HSCT technology have improved outcomes and increased the availability of this technique; however, this procedure can also significantly influence the socioeconomic wellbeing of patients, especially in developing countries. Our study highlights the feasibility of performing HSCT in Mexico at lower costs than developed countries, while preserving quality of care.
美国异基因造血干细胞移植（HSCT）的成本已有广泛报道，但发展中国家的完整成本信息却很缺乏。我们开展了一项分析，旨在评估墨西哥HSCT的实际详细成本。利用我们机构往来账户部门的数据库，我们对2010年至2015年的患者进行了基于微观成本核算的分析，以获取住院期间及2个月随访期内HSCT的总成本。共进行了105例移植（57%为自体移植）。最常见的移植适应症是淋巴瘤（32%），其次是急性白血病（22%）。最常用的预处理方案是改良白消安-环磷酰胺方案（BUCY 2，38%），其次是卡莫司汀-依托泊苷-阿糖胞苷-美法仑方案（BEAM，28%）。在移植后并发症中，急性移植物抗宿主病与较高成本无关（p = 0.8）。自体和异基因HSCT的中位成本（住院及2个月门诊随访）分别为12,155美元和18,260美元。HSCT技术的进步改善了治疗效果并增加了该技术的可及性；然而，该治疗方法也会显著影响患者的社会经济福祉，尤其是在发展中国家。我们的研究强调了在墨西哥以低于发达国家的成本进行HSCT的可行性，同时保持医疗质量。
