Achour Leila, Drira Chema, Sboui Mohamed Zied, Fazaa Ikram, Soussi Mohamed Ali, Hammami Senda, Ben Othman Tarek, Razgallah Khrouf Myriam
Pharmacy department, Bone Marrow Transplant Center of Tunisia, Tunis, Tunisia.
Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Bone Marrow Transplant Center of Tunisia, Tunis, Tunisia.
J Mark Access Health Policy. 2023 Aug 9;11(1):2236851. doi: 10.1080/20016689.2023.2236851. eCollection 2023.
New procedures and diagnostic tests in hematopoietic stem cell transplantation (HSCT) are associated with a significant increase in costs. The last cost estimate of allogeneic HSCT done in Tunisia was in 1996 and concerned only direct medical costs. Therefore, an updated cost analysis is needed. Analysis of direct costs during the first-year post-allogeneic HSCT in two groups of patients: Bone Marrow Transplant (Allo-BMT) and Peripheral Blood Stem Cell Transplant (Allo-PBSCT) and identification of factors leading to interindividual variations in costs in order to compare these costs with the budget allocated by the payer (CNAM). Pharmacoeconomic retrospective study, concerning patients who underwent allogeneic HSCT in 2013. Clinical and unit cost data were obtained from medical and administration records. This study showed that the average direct cost of allogeneic HSCT in the population during the first year reached 56 638€. The average cost of Allo-BMT was 63 612€, and Allo-PBSCT was 45 966€ ( > 0.05). The initial hospitalization counted for 88% of total direct cost with an average cost of 41 441€ in Allo-BMT and 24 672€ in Allo-PBSCT ( < 0.05). Direct medical costs represented more than 70% of total direct costs, drugs, and laboratory tests occupied the largest share. Antifungals, antitumors, and antiviral drugs were the most expensive pharmaceutical classes with a mean cost, respectively, of 4 526€; 3 737€ and 3 268€. Some clinical criteria were significantly related to total direct costs like length of aplasia ( < 0.01) and GVHD ( < 0.05). However, the type of blood disease, its risk, length of mucositis, and the treatment protocol have no effect on the costs for all allogeneic patients. Our results showed that the costs of Allo HSCT have exceeded by far the budget allocated by the CNAM to the center, since the 90s to this day. That's why the total reimbursement mechanism should be revised.
造血干细胞移植（HSCT）中的新程序和诊断测试导致成本大幅增加。突尼斯上一次对异基因HSCT的成本估计是在1996年，且仅涉及直接医疗成本。因此，需要进行一次更新的成本分析。对两组患者在异基因HSCT后第一年的直接成本进行分析：骨髓移植（Allo - BMT）和外周血干细胞移植（Allo - PBSCT），并确定导致个体成本差异的因素，以便将这些成本与付款方（CNAM）分配的预算进行比较。对2013年接受异基因HSCT的患者进行药物经济学回顾性研究。临床和单位成本数据来自医疗和行政记录。该研究表明，该人群在第一年异基因HSCT的平均直接成本达到56638欧元。Allo - BMT的平均成本为63612欧元，Allo - PBSCT为45966欧元（P>0.05）。初始住院费用占总直接成本的88%，Allo - BMT的平均成本为41441欧元，Allo - PBSCT为24672欧元（P<0.05）。直接医疗成本占总直接成本的70%以上，药物和实验室检查占最大份额。抗真菌药、抗肿瘤药和抗病毒药是最昂贵的药物类别，平均成本分别为4526欧元、3737欧元和3268欧元。一些临床标准与总直接成本显著相关，如再生障碍期长度（P<0.01）和移植物抗宿主病（P<0.05）。然而，血液疾病类型、其风险、粘膜炎长度和治疗方案对所有异基因患者的成本没有影响。我们的结果表明，自90年代至今，异基因HSCT的成本远远超过了CNAM分配给该中心的预算。这就是为什么应该修订总报销机制的原因。
