A detailed analysis of charges for hematopoietic stem cell transplantation at a children’s hospital

Summary: as stem cell transplantation is an initial step in cost containment. We analyzed hospital charges for pediatric hematopoi- Keywords: bone marrow transplantation/economics; etic stem cell transplantation (HSCT) to understand costs and cost analysis; economics; pediatrics better the medical origin of these charges. Forty-nine patients undergoing HSCT at Kosair Children’s Hospital between January 1992 and August 1995 had hospital charges analyzed by cost center, donor type and clinical Health care costs are an increasingly important consideroutcome. Thirty-three autologous, two syngeneic and 14 ation in health care delivery. In the USA, federal and state allogeneic transplants were performed. Twenty-four governments, as well as business have encouraged a trantransplants were performed for hematological malig- sition to a ‘business model of medicine’ resulting in a pronancies, 22 for solid tumors, and three for non-malig- liferation of for-profit managed care corporations that seek nant diseases. Pharmaceutical charges comprised the to contain costs by applying competitive pressures to health largest single component of total hospital charges care providers. In Europe and Canada, rising health care (THC), accounting for 38.9%. Room charges were the costs are increasingly being constrained by shrinking next largest group at 33.7% of THC. Other cost centers, government budgets. in order of magnitude, were central supply (7.9%), Technologically advanced medical procedures such as transfusion services (7.5%), laboratory (5.8%), micro- hematopoietic stem cell transplantation (HSCT) are biology (3.6%), miscellaneous (1.9%), and radiology extremely vulnerable to these cost-cutting measures since (1.4%). Within the pharmaceutical cost center, colony- they consume a large amount of resources, while providing stimulating factors comprised the largest single item, benefits to a relatively small number of people. For making up 18% of total pharmacy charges and 7% of instance, in the USA, the most costly 5% of the pediatric THC. Antibiotics were the second largest component, at population (to age 18) accounts for 59% of US health care 16% of pharmacy charges and 6% of THC. Patients expenditures on children, while the most expensive 1% transferred to the intensive care unit (ICU) had charges account for 37%. 1 In adult medicine, an analogous statistic 68% greater than non-ICU patients. Allogeneic trans- reveals that 44% of Medicare (Government health care plant patients had THC 35% greater than autologous benefits for those over 65 years) expenditures are spent on transplant patients, but also a four-fold greater chance the sickest 4% of the Medicare population, while the sickest of becoming an ICU patient. THC for non-ICU allo- 11% of that population account for 73% of expenditures. 2 geneic transplant patients were 18% greater than for Clearly, if cost containment issues are to be addressed, autologous non-ICU patients. THC for allogeneic ICU one must understand the genesis of costs for specific treatpatients were 21% greater than for autologous ICU ments and procedures. With this goal in mind, a detailed patients. Patients who died of transplant-related toxicity cost analysis of stem cell transplants performed at a 255prior to day 100 had THC 83% greater than those who bed freestanding children’s hospital in the USA between survived beyond day 100. This is the first published 1992 and 1995 was carried out. comprehensive and detailed analysis of charges associa- A large body of literature has focused on the total costs