Cost analysis of allogeneic hematopoietic stem cell transplantation before and after the implementation of therapeutic drug monitoring

IF 1.5 Q3 HEMATOLOGY

Hematology, Transfusion and Cell Therapy Pub Date : 2026-10-01 Epub Date: 2026-09-28 DOI:10.1016/j.htct.2026.106516

Joice Zuckermann, Ana Paula Beck da Silva Etges, Bruno Mateus de Castro, Renata Garcia Ruschel, Luciana Rodrigues de Lara, Lucas Bastos Beltrami, Elenita Teresinha Chagas, Liane Esteves Daudt, Alessandra Aparecida Paz, Leila Beltrami Moreira

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Abstract

Objectives

To estimate the costs of allogeneic hematopoietic stem cell transplantation before and after the implementation of therapeutic drug monitoring.

Methods

A retrospective cohort study with historical controls included adult and pediatric patients undergoing related, unrelated and haploidentical allogeneic hematopoietic stem cell transplantation from December 2014 to December 2021. The therapeutic drug monitoring (cyclosporine, tacrolimus, and busulfan) group (TDM Group) was compared to a Control Group without therapeutic drug monitoring. A microcosting study based on Time-Driven Activity-based Costing was conducted to assess the hospitalization cost of hematopoietic stem cell transplantation patients. The values of medications and materials were adjusted for inflation to December 2022 and expressed in U.S. dollars

Results

Forty-four patients were included in both groups, with data collection from December 2014 to December 2017 (Control Group) and from January 2019 to December 2021 (TDM Group). The average cost per transplantation patient in the entire cohort was US$ 29.604,23 (SD: ± US$ 27.070,00). The hospitalization cost was US$ 32,639.81 (SD ± 31,903.45) for patients in the Control Group and US$ 26,568.65 (SD: ± US$ 21,013.31) for the TDM Group. Regarding the tests performed, the Control Group resulted in a mean cost of US$ 2338.59, with a reduced cost in the TMD Group to US$ 1391.94 (p-value <0.001). The component with the most significant impact on the total cost was medications, with an overall average of US$ 17,728.43 (SD: ± US$ 24,035.77).

Conclusion

The total hospitalization cost for allogeneic hematopoietic stem cell transplantation did not differ significantly between groups, but the TDM Group showed lower exam and medication expenditures, suggesting economic benefits. Despite similar overall costs, therapeutic drug monitoring may provide advantages in other clinical outcomes not assessed in this study. Further research is warranted to explore these endpoints.

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同种异体造血干细胞移植实施治疗药物监测前后的成本分析。

目的：评估同种异体造血干细胞移植实施治疗药物监测前后的成本。方法：回顾性队列研究，纳入2014年12月至2021年12月接受相关、非相关和单倍体同种异体造血干细胞移植的成人和儿童患者。将治疗药物监测组（环孢素、他克莫司、布硫凡）与不进行治疗药物监测的对照组（TDM组）进行比较。采用基于时间驱动的作业成本法对造血干细胞移植患者住院费用进行微观成本研究。结果：两组共纳入44例患者，数据收集时间分别为2014年12月至2017年12月（对照组）和2019年1月至2021年12月（TDM组）。在整个队列中，每个移植患者的平均费用为29.604.23美元（标准差：±27.070000美元）。对照组患者住院费用为32,639.81美元（SD±31,903.45），TDM组住院费用为26,568.65美元（SD：±21,013.31美元）。在进行的检查方面，对照组的平均费用为2338.59美元，TMD组的费用降低至1391.94美元（p值）。结论：同种异体造血干细胞移植的总住院费用在两组之间没有显著差异，但TDM组的检查和药物费用较低，表明经济效益。尽管总体成本相似，但治疗性药物监测可能在本研究未评估的其他临床结果中具有优势。需要进一步的研究来探索这些终点。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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