P-367: COST ANALYSIS FOR ADULT PATIENTS WITH MULTIPLE MYELOMA UNDERGOING AUTOLOGOUS HEMATOPOIETIC CELL TRANSPLANTATION

Introduction: Multiple myeloma (MM) is a malignant hematological disease diagnosed by presence of clonal plasma cells in the bone marrow. Hematopoietic cell transplantation (HCT) is indicated for eligible patients and prolongs progression free survival. Despite its fundamental role in increasing efficiency in the allocation of resources by transplant programs, few studies have been published on the costs of HCT. Therefore, economic evaluation studies in the transplant scenario are extremely important to help improve the management of the procedure worldwide.


Methods: This cost cohort study of adult MM patients who underwent the first autologous HCT. Period of analysis 01/2010 to 12/2021 from D+30. The method used for cost analysis was absorption costing and the effect of inflation was eliminated by using the hospital's standard cost table in force in October 2023 and the currency converison used was the average of the daily monthly values for 2023 (R$4.99).

Results: The study included 85 patients; median age was 60 years and there was a male predominance, 55% (47), (table 1). The total median cost at D+30 was $ 19.704,34 ($ 17.493,43 - $ 25.625,18). When analyzing the median cost by stratification of service categories in the D+30, the biggest cost offenders were materials: $ 12,432.87 ($ 5,177.17 - $ 22,560.06) and daily: $ 12,087.76 ($ 8,155.69 - $ 18,165.63).

Table 1. Demographic and HCT data

VARIABLES		Total N(%) N=85	≤ 60 years N=45	> 60 years N=40	p-value
SEX	FEMALE	38 (45%)	20 (44%)	18 (45%)	0,43
	MALE	47 (55%)	25 (56%)	22 (55%)
MEDIAN AGE (IQR)*		60 (55 - 64)	55 (50 - 58)	65 (63 – 68)	< 0,01
KARNOFSKY	< = 80%	5 (6%)	1	4	0,73
	90%	14 (16%)	5	9
	100%	66 (78%)	39	27
MEDIAN LENGTH OF STAY (IQR)*		19 (17 - 21)	18 (17 – 21)	19 (18 – 21)	0,72
CONDITIONING	Mel 200 mg/m²	80 (94%)	43 (96%)	37 (93%)	**
	Mel 140 mg/m²	4 (4%)	1 (2%)	3 (7%)
	Bu+Mel	1 (2%)	1 (2%)	0 (0%)
CELL SOURCE	PBPC	82 (97%)	42 (93%)	40 (100%)	**
	BM	1 (1%)	1 (2%)	0 (0%)
	BM + PBPC	2 (2%)	2 (5%)	0 (0%)
TOTAL COSTS (IQR)*		$ 19,704.34 ($ 17,493.43 - $ 25,625.18)	$ 20,694.27 ($ 18,332.41 - $ 31,014.69)	$ 19,164.24 ($ 17,170.65 - $ 20,675.27)	0,06

IQR* = interquartile range / ** = not applicable as it contains groups with no individuals












Conclusions: The main contributors to MM's costs were materials and per diems. This result is justified by the daily exams and the materials to treat the patient. According to DATASUS in 2023, 1,851 autologous HCT were performed, with an average cost of R$5,132.15 and an average length of stay of 15.2 days. The HCT average cost in SUS compared with the median cost in our institution on D+30, the values were 3.8 higher than the reimbursement made by SUS. In addition to more days of hospitalization, the difference in price could probably be an indication of the use of the institution's infrastructure, in addition to hotel services. Despite higher prices than SUS, the costs of transplant are lower than several new treatments available for Multiple Myeloma.