Costs of autologous stem-cell transplantation in solid tumours.

Dr Astier and co-workers report on the costs of high-dose chemotherapy (HDC) and autologous peripheral blood stem-cell transplantation (APBSCT) in patients with solid tumours. The authors analyse in great detail the direct and indirect costs of the procedure in 27 consecutive patients treated in a single institution and conclude that the mean overall cost is 21,445 US dollars. The results obtained by the Spanish study are in accordance with previous reports and our own experience (see below). All the cost-analyses regarding APBSCT have so far considered stem cell support following high-dose, myeloablative chemotherapy However, in recent years this approach has been increasingly used with less intensive chemotherapy regi-mens. In particular, critical economic issues are raised when PBSC reinfusion is used solely as a supportive (sometimes cosmetic?) measure following non-myeloablative courses of chemotherapy [1, 2] In those cases the procedure, often within multiple transplant programs, is also feasible and safe in the outpatient setting. In contrast, myeloablative chemotherapy usually requires extended hospitalisation, intensive nursing care and expensive supportive measures. We evaluated the overall costs of four different approaches of autologous transplantation, two including a myeloablative regimen [3, 4] and two following 'intermediate-dose' treatments [1, 2] As expected our data show a wide range of resource utilisation among different approaches of APBSCT (Table 1) which relate to the intensity of the chemotherapy regimen delivered. From the economic point of view it would be interesting to know how these procedures are reimbursed throughout Europe. In fact, the ICD9-CM classification system, which is utilised in most European countries, considers one possible procedure (autologous hematopoietic stem-cell transplantation 41.04, DRG 481) which can be used in this clinical setting Reimbursement by the National Health Service, at least in Italy, for DRG 481 is adequate to cover the costs of myeloablation with APBSCT However, the use of code 41 04 for much less expensive intensified, non-myeloablative, chemotherapy regimens (often multiple) may represent an easy way to balance hospital budgets and cause additional costs for National Health Services Table 1 Overall costs of four different chemotherapy approaches with stem-cell support HDS ICE HDCE HD FEC [3] [4] [I] [2] The direct costs for health care personnel were calculated by dividing the total expenses for all patients by the total number of minutes spent for the single patient All direct costs were estimated by calculating the precise managing costs from the clinical record while the indirect costs were estimated …