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

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.