Abstract
The thalassemias are a heterogeneous group of inherited hypochromic anemias of varying severity. The mainstay of supportive treatment is regular blood transfusion accompanied by iron-chelating therapy. Hematopoietic stem cell transplantation (HSCT) provides an alternative option when curative therapy is considered. More than 400 patients in Taiwan have β-thalassemia major or other transfusion-dependent thalassemias, and their treatment costs account for a considerable percentage of the National Health Insurance expenditure. In this report, we estimated the treatment costs of conventional therapy (regular blood transfusion accompanied by iron-chelating agents) and HSCT. The undiscounted medical cost of 20 years of follow-up (20 years from diagnosis) and the undiscounted total lifetime cost were NT$ 4 739 888 (NT$ means New Taiwan Dollars)/US$ 149 288 and NT$ 11 529 990/US$ 363 149, respectively, for patients undergoing conventional therapy, and NT$ 2 639 982/US$ 83 149 and NT$ 3 511 172/US$ 110 588, respectively, for those undergoing successful HSCT. Comparisons of treatment costs and other parameters between these two modalities can add to the information base on which policy is made by health authorities or clinicians.
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References
Rund D, Rachmilewitz E . New trends in the treatment of beta-thalassemia. Crit Rev Oncol Hematol 2000; 33: 105–118.
Lawson SE, Roberts IA, Amrolia P, Dokal I, Szydlo R, Darbyshire PJ . Bone marrow transplantation for beta-thalassemia major: the UK experience in two paediatric centres. Br J Hematol 2003; 120: 289–295.
Modell B, Khan M, Darlison M . Survival in beta-thalassemia major in the UK: data from the UK thalassemia register. Lancet 2000; 355: 2051–2052.
Wonke B . Clinical management of beta-thalassemia major. Semin Hematol 2001; 38: 350–359.
Karnon J, Zeuner D, Brown J, Ades AE, Wonke B, Modell B . Lifetime treatment cost of beta-thalassemia major. Clin Lab Haematol 1999; 21: 377–385.
Ginsberg G, Tulchinsky T, Filon D, Goldfarb A, Abramov L, Rachmilevitz EA . Cost-benefit analysis of a national thalassaemia prevention programme in Israel. J Med Screen 1998; 5: 120–126.
Lin KH . Pediatric hematopoietic stem cell transplantation in Taiwan. Transplant Proc 1998; 30: 3477–3480.
Borgna-Pignatti C, De Rugolotto SSP, Di Piga AGF, Gamberini MR, Sabato V, Melevendi C et al. Survival and disease complications in thalassemia major. Ann NY Acad Sci 1998; 850: 227–231.
Olivieri NF . The beta-thalassemias (published erratum appears in new England journal of medicine 1999, 341, 1407). N Engl J Med 1999; 341: 99–109.
Hwang JS, Wang JD . Monte carlo estimation of extrapolation of quality-adjusted survival for follow-up studies. Statist Med 1999; 18: 1627–1640.
Piga A, Longo F, Consolati A . Mortality and morbidity in thalassemia with conventional treatment. Bone Marrow Transplant 1997; 19: 11–13.
Galimberti M, Lucarelli G, Polchi P . HLA-mismatched bone marrow transplantation in thalassemia. Bone Marrow Transplant 1991; 7 (S7): 98–100.
Sullivan KM, Anasetti C, Horowitz M, Rowlings PA, Petersdorf EW, Martin PJ et al. Unrelated and HLA-nonidentical related donor marrow transplantation for thalassemia and leukemia. Ann NY Acad Sci 1998; 850: 312–324.
Contu L, La Nasa G, Arras M, Ledda A, Pizzati A, Vacca A et al. Successful unrelated bone marrow transplantation in beta-thalassemia. Bone Marrow Transplant 1994; 13: 329–331.
Mentzer WC, Cowan MJ . Bone marrow transplantation for beta-thalassemia: the university of California San Francisco experience. J Pediatr Hematol/Oncol 2000; 22: 598–601.
Issaragrisil S, Visuthisakchai S, Suvatte V, Tanphaichitr VS, Chandanayingyong D, Schreiner T et al. Transplantation of cord blood stem cells into a patient with severe thalassemia. N Engl J Med 1995; 332: 367–369.
Kelly P, Kurtzberg J, Vichinsky E, Lubin B . Umbilical cord blood stem cells: application for the treatment of patients with hemoglobinopathies. J Pediatr 1997; 130: 695–703.
Miniero R, Rocha V, Saracco P, Locatelli F, Brichard B, Nagler A et al. Cord blood transplantation (CBT) in hemoglobinopathies. Bone Marrow Transplant 1998; 22 (S1): S78–S79.
Roberts IAG, Darbyshire PJ, Will AM . BMT for children with thalassemia major in the UK. Bone Marrow Transplant 1997; 19: 60–61.
Cappellini MD . Iron-chelating therapy with the new oral agent ICL670 (Exjade®). Best Pract Res Clin Haematol 2005; 18: 289–298.
Mourad FH, Hoffbrand AV, Sheikh-Taha M, Koussa S, Khoriaty AI, Taher A . Comparison between desferrioxamine and combined therapy with desferrioxamine and deferiprone in iron overloaded thalassaemia patients. Br J Haematol 2003; 121: 187–189.
Acknowledgements
We thank Ms Cheng-Fen Yu for her statistical help. This project was partially supported by the National Health Research Institutes No.NHRI-EX94-9204PP.
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Ho, WL., Lin, KH., Wang, JD. et al. Financial burden of national health insurance for treating patients with transfusion-dependent thalassemia in Taiwan. Bone Marrow Transplant 37, 569–574 (2006). https://doi.org/10.1038/sj.bmt.1705287
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DOI: https://doi.org/10.1038/sj.bmt.1705287
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