Expenses Incurred from Planning of BMT to Completion of BMT Procedure

Expenses involved can be divided into two i.e. on the Patient and the Donor.

Expenses Incurred on the Patients

Investigations

• Prior to BMT: HLA typing and other related tests, complete and thorough assessment of disease status and organ functions.
• In the first 30 days of BMT: Routine and special blood tests and radiological investigations.The investigations carried out during the first 30 days are very frequent and extensive.
• In the first 100 days post BMT: At least twice/thrice a week monitoring with blood tests for bone marrow function, liver and kidney functions and molecular tests for viral infections. Repeated bone marrow examination to look for disease status and percentage of donor cells.
• Beyond 100 days: The frequency of investigations decreases, if there are no complications.

Drugs, Disposables and Consumables

This is the most expensive component of the expenses and involves the following:-

Drugs

• High Doses of Chemotherapy / other Drugs used for Conditioning.
• Routine drugs to prevent infections.
• Antibiotics, Antifungal and Antiviral drugs to treat infections.
• Growth factors for stimulating marrow after transplantation to promote engraftment.
• Immune suppressants to prevent and treat Graft Versus Host Disease.
• Drugs required to treat complications like injury to liver, lungs, kidney etc.
• Parenteral nutrition.

Disposables and Consumables

• In order to prevent infection to the patient, a lot more sterile and disposable items are used for patients undergoing BMT compared to other patients undergoing high end surgery or other interventions

Procedure charges and professional fees

BMT Physician Charges include

• Planning and execution of the transplantation
• Round the clock care of the patient for the entire duration of the hospital stay
• Rigorous and Intensive care and monitoring of the patient for months to years after discharge from the hospital
• Procedure Charges for :
  • Diagnostic Procedures for patient work up
  • Insertion of Hickman’s line
  • Harvesting of graft
  • Processing of graft
  • Cryopreservation of graft
  • Transfusion of graft
  • Any other procedure

Radiotherapy Charges

Cost of Radiotherapy as a part of ‘CONDITIONING’.

Cost of blood and blood components

• Cost of collecting single donor platelets.
• Cost of leukodepletionof blood.
• Cost of Irradiation of blood.

Hospitalisation Cost

• Isolation of patient in BMT unit (a highly specialised clean room environment) for one month to guard against infections and constant monitoring.

Expenses Incurred on the Donor

Investigation for donor selection and donor work up

To select a suitable donor, multiple donors have to undergo various investigations before a suitable donor is selected.

Graft Harvesting

Once the suitable donor is selected he has to be

• Injected with growth factor.
• Admission for 2 days in the hospital for Peripheral Blood Stem Cell Harvest on the apheresis machine or Bone Marrow Harvest under General Anaesthesia.

Graft Processing Cost

Bone Marrow Graft

• Red Cell and/or Plasma Depletion

PBSC Graft

• T cell depletion
• Clinimacs based processing for Haploidentical BMT

Graft Storage (Mostly done for Autologous BMT)

• Processing of PBSC graft using DMSO (a chemical used to protect stem cells from extreme subzero temperature).
• Prolonged storage at -196⁰C temperature in a Cryofreezer after controlled rate freezing.