International Journal of Hematology

, Volume 106, Issue 4, pp 573–580 | Cite as

Costs of hematopoietic stem cell transplantation in a developing country

  • Monica M. Rivera-Franco
  • Eucario Leon-Rodriguez
  • Haydee L. Castro-Saldaña
Original Article


Costs of HSCT in the United States have been widely reported, but complete information on costs in developing countries is lacking. We performed an analysis designed to assess the real, detailed costs of HSCT in Mexico. Using the database of the Current Accounts Department at our Institution, we performed a micro-costing based analysis of patients from 2010 through 2015 to obtain the overall cost of HSCT during the in-patient procedure and 2-month follow-up. One hundred five transplantations (57% autologous) were performed. The most frequent indications for transplantation were lymphomas (32%), followed by acute leukemias (22%). The most frequently used conditioning regimen was reduced BUCY 2 (38%), followed by BEAM (28%). Among post-transplant complications, acute graft-versus-host-disease was not associated with higher costs (p = 0.8). The median costs (in-patient and 2-month outpatient follow-up) for auto and allo-HSCT were 12,155 and 18,260 USD, respectively. Advances in HSCT technology have improved outcomes and increased the availability of this technique; however, this procedure can also significantly influence the socioeconomic wellbeing of patients, especially in developing countries. Our study highlights the feasibility of performing HSCT in Mexico at lower costs than developed countries, while preserving quality of care.


Hematopoietic stem cell transplantation Micro-costing Developing countries 



We thank the non-governmental, non-profit organization “Unidos…Asociacion Pro Trasplante de Medula Osea”, in Mexico City, Mexico, for supplying medicines for our patients and providing emotional support for them and their families.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Pasquini MC, Zhu X. Current uses and outcomes of hematopoietic stem cell transplantation: CIBMTR Summary Slides; 2015.
  2. 2.
    Gratwohl A, Baldomero H, Aljurf M, Pasquini MC, Bouzas LF, Yoshimi A, et al. Hematopoietic stem cell transplantation: a global perspective. JAMA. 2010;303(16):1617–24.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Khera N, Zeliadt SB, Lee SJ. Economics of hematopoietic cell transplantation. Blood. 2012;120(8):1545–51.CrossRefPubMedGoogle Scholar
  4. 4.
    Preussler JM, Denzen EM, Majhail NS. Costs and cost-effectiveness of hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2012;18(11):1620–8.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Khera N, Emmert A, Storer BE, Sandmaier BM, Alyea EP, Lee SJ. Costs of allogeneic hematopoietic cell transplantation using reduced intensity conditioning regimens. Oncologist. 2014;19(6):639–44.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Khera N, Chang YH, Hashmi S, Slack J, Beebe T, Roy V, et al. Financial burden in recipients of allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transpl. 2014;20(9):1375–81.CrossRefGoogle Scholar
  7. 7.
    Kim W, McNulty J, Chang YH, Weise M, Hashmi S, Ailawadhi S, et al. Financial burden after allogeneic hematopoietic cell transplantation: a qualitative analysis from the patient’s perspective. Bone Marrow Transpl. 2015;50(9):1259–61.CrossRefGoogle Scholar
  8. 8.
    Chino F, Peppercorn J, Taylor DH, Lu Y, Samsa G, Abernethy AP, et al. Self-reported financial 135 burden and satisfaction with care among patients with cancer. Oncologist. 2014;19(4):414–20.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Eckrich M, Pasquini M. Hematopoietic cell transplantation in Latin America. Hematology. 2012;17(suppl 1):S189–91.PubMedGoogle Scholar
  10. 10.
    LeMaistre CF, Farnia S, Crawford S, McGuirk J, Maziarz RT, Coates J, et al. Standardization of terminology for episodes of hematopoietic stem cell patient transplant care. Biol Blood Marrow Transpl. 2013;19(6):851–7.CrossRefGoogle Scholar
  11. 11.
    Xu X, Grossetta Nardini HK, Ruger JP. Micro-costing studies in the health and medical literature: protocol for a systematic review. Syst Rev. 2014;3:47.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Stranges ETR, Russo CA, Friedman B. Procedures with the most rapidly increasing hospital costs, 2004–2007 [HCUP Statistical Brief 82]. Rockville: Agency for Healthcare Research and Quality; 2009.Google Scholar
  13. 13.
    Saito AM, Cutler C, Zahrieh D, Soiffer RJ, Ho VT, Alyea EP, et al. Costs of allogeneic hematopoietic cell transplantation with high-dose regimens. Biol Blood Marrow Transpl. 2008;14(2):197–207.CrossRefGoogle Scholar
  14. 14.
    Lee SJ, Klar N, Weeks JC, Antin JH. Predicting costs of stem-cell transplantation. J Clin Oncol. 2000;18(1):64–71.CrossRefPubMedGoogle Scholar
  15. 15.
    Majhail NS, Rizzo JD, Hahn T, Lee SJ, McCarthy PL, Ammi M. Pilot study of patient and caregiver out-of-pocket costs of allogeneic hematopoietic cell transplantation. Bone Marrow Transpl. 2013;48(6):865–71.CrossRefGoogle Scholar
  16. 16.
    Ruiz-Delgado GJ, Ruiz-Argüelles GJ. A Mexican way to cope with stem cell grafting. Hematology. 2012;17(Suppl 1):S195–7.PubMedGoogle Scholar
  17. 17.
    Ruiz-Argüelles Guillermo J. Stem cell transplantation procedures are becoming affordable for individuals living in developing (middle-income) countries. Acta Haematol. 2016;135:79–80.CrossRefPubMedGoogle Scholar
  18. 18.
    Saito AM, Zahrieh D, Cutler C, Ho VT, Antin JH, Soiffer RJ, et al. Lower costs associated with hematopoietic cell transplantation using reduced intensity vs high-dose regimens for hematological malignancy. Bone Marrow Transpl. 2007;40(3):209–17.CrossRefGoogle Scholar
  19. 19.
    Lin YF, Lairson DR, Chan W, Du XL, Leung KS, Kennedy-Nasser AA, et al. The costs and cost-effectiveness of allogeneic peripheral blood stem cell transplantation versus bone marrow transplantation in pediatric patients with acute leukemia. Biol Blood Marrow Transpl. 2010;16(9):1272–81.CrossRefGoogle Scholar
  20. 20.
    Denzen EM, Thao V, Hahn T, Lee SJ, McCarthy PL, Rizzo JD, et al. Financial impact of allogeneic hematopoietic cell transplantation on patients and families over 2 years: results from a multicenter pilot study. Bone Marrow Transpl. 2016;51(9):1233–40.CrossRefGoogle Scholar
  21. 21.
    OECD. OECD reviews of health systems: Mexico. Paris: OECD Publishing; 2016. doi: 10.1787/9789264230491-en.Google Scholar

Copyright information

© The Japanese Society of Hematology 2017

Authors and Affiliations

  • Monica M. Rivera-Franco
    • 1
  • Eucario Leon-Rodriguez
    • 1
  • Haydee L. Castro-Saldaña
    • 2
  1. 1.Hematology and Oncology DepartmentInstituto Nacional de Ciencias Medicas y Nutricion Salvador ZubiranMexico CityMexico
  2. 2.Current Accounts DepartmentInstituto Nacional de Ciencias Medicas y Nutricion Salvador ZubiranMexico CityMexico

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