To analyze resource usage and costs of patients who underwent Hematopoietic Stem Cell Transplantation (HSCT) in the Brazilian Supplementary Health System (SHS).

Data from a longitudinal retrospective dynamic cohort study (from January/2014 to December/2019) were analyzed. The population consisted of SHS patients who underwent HSCT (regardless of being autologous, allogeneic related or unrelated), and were beneficiaries of one of the 15 main health maintenance organizations that use Orizon billing system (25% of total Brazilian private market). The follow-up period ranged from six months prior to HSCT, to identify the total costs of hospitalization and preparatory exams for the procedure, up to one year after HSCT, or until censored/death.

1,265 HSCT procedures were analyzed (1,132 patients). Sex and age were missing data in 40% of the patients’ records, however from the data that were possible to collect, 33.0% were males, and 42.75% were between 30 and 70 years old. The most common causes for transplant were Multiple Myeloma (ICD-10 C90.0) and Acute Myeloid Leukemia (C92.0). During the six months that precede transplant, each patient cost an average of BRL 303,500 (total cohort cost of BRL 383.6 million, 55% of this total consisting of hospitalization expenses). During hospitalization for HSCT procedure, 41.2% of patients were admitted to the ICU, with a median length of stay of 21 days. Total hospitalization costs for transplant in this cohort was BRL 503.4 million (average of BRL 398,000 per patient). Additionally, 4.24% of patients presented an immediate adverse event after HSCT. Graft-Failure (T86.0) was the most common event (26,19%). Of the 1,132 patients followed, 26% had new admissions within one month after transplant; Acute Myeloid Leukemia and Multiple Myeloma relapse were the most common causes for re-hospitalization, followed by other transplanted organs and tissues (Z94.8), Acute Lymphoblastic Leukemia (C91.0), unspecified medical care (Z51.9), Cytomegalovirus unspecified disease (B25.9) and unspecified fever (R50.9). The highest costs after discharge from transplant were associated to hospitalizations (BRL 231 million in total, average of BRL 67,300 per hospitalization).

HSCT is a growing procedure in the SHS in Brazil, and is associated with high costs, especially those with repeated hospitalizations, either caused by diseases that were the primary cause for HSCT indication or by infections after the procedure. The comprehension on HSCT-related costs in Brazilian SHS setting can help to define actions oriented to a improve patients’ quality of life and treatment strategies, thus achieving better patients’ outcomes. This study was sponsored by Novartis Pharmaceuticals Corporation. Dr. Funke and Dr. Schmidt-Filho have participated on this study for the sole purpose of scientific exchange and report no conflicts of interest.