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Costs of bone marrow transplants using unrelated donors

1991; Elsevier BV; Volume: 5; Issue: 2 Linguagem: Inglês

10.1016/0268-960x(91)90043-c

1532-1681

Jeremy R. Chapman, K Atkinson, Helen Lapsley,

Chronic Myeloid Leukemia Treatments

Bone marrow transplantation is an expensive treatment, rationed primarily by the availability of donors. Recruiting potential unrelated bone marrow donors to a register would add not only to the cost, but also to the volume, of transplantation. Proposals to establish such registries have thus been subject to rigorous financial scrutiny. In Australia, 3 alternative estimates suggest that approximately 200 patients, otherwise suitable for bone marrow transplantation, do not receive transplants because they have no suitable related donor. The population of Australia is approximately 16 million. The alternatives for these patients are thus chemotherapy or unrelated bone marrow transplantation. The costs of chemotherapy and transplantation have been directly compared in 1 trial of treatment for acute nonlymphoblastic leukaemia. The cost per year of life saved was approximately the same for the 2 treatments, with better patient survival from transplantation. The estimated cost difference in both the United States and Australia, between the policy extremes of no patients transplanted, and all transplanted, was between 1.3–2.4% of the total costs of managing these patients. The cost of searching existing registers for unrelated donors for Australian patients, averages A$24 000–28 000 to the point of a successful donor procedure. The cost of establishing and maintaining an Australian Register of a size predicted to find donors for half of the potential recipients, has been estimated at A$ 10 000 per donor procedure. The decision to proceed with unrelated bone marrow transplantation commits resources that are currently used by the alternative therapies. It is thus important to monitor both the costs and effects of the new approach. The medical efficacy of bone marrow transplantation from matched but unrelated donors has been under discussion in Australia for the past 5 years. It is not the subject of this review to outline the progress of that debate. On the basis of both local and international experience, the conclusion has been to propose that matched unrelated bone marrow transplants should no longer be considered experimental. In Australia, as in many other countries making a similar decision, the cost of both establishing this therapy and of recruiting potential donors to a register has come under scrutiny. While therapies of uncertain efficacy and indeterminate but large financial cost have become established by tradition in hospitals throughout the world, modern therapy, where it is perceived to be expensive, must account not only to the yardstick of efficacy but also to that of the budget. It is appropriate to analyse medical management in terms of its cost to the community, since the community must forgo some other expenditure to pay for it. This paper thus reviews the financial arguments that have followed from the these policy decisions.