Abstract
Introduction: Hematopoietic stem cell transplantation (HSCT), indicated for the treatment of malignant hematologic diseases such as leukemia and non-malignant diseases such as bone marrow failure (MBF), hemoglobinopathies, and immunodeficiency, aims to replace diseased or deficient bone marrow with normal cells. It is a highly complex process that requires multidisciplinary action and resource management, from donor selection to post-HSCT follow-up, in favor of disease-free survival. Objective: To analyze the journey and costs related to HSCT of pediatric patients with leukemia or MBF, considering the perspectives of Public Health (SUS) and Supplementary Health. Material and Method: Retrospective cohort (CAAE: 77859224.8.0000.5580), with mapping by place of hospitalization to develop the patient journey, and bottom-up analysis of HSCT costs, attended from December/2021 to January/2023 in a pediatric hospital in southern Brazil. Only direct medical costs (medications, exams and procedures, and hospitalizations, both in the ward and in the intensive care unit - ICU) were collected from each patient's reimbursement. Results: A total of 24 patients were included, 42% (n = 10) with FM [60% male (n = 6), 60% SUS (n = 6)]. And 58% with leukemia (n = 14) [64% male (n = 9), 71% SUS, (n = 10)]. The average cost of SUS care was R$101,020.83 per patient for FM (Severe Aplastic Anemia (SAA) and Fanconi anemia) and R$85,639.47 for leukemias [Acute Lymphoid Leukemia (ALL) and Acute Myeloid Leukemia (AML)]; for Supplementary Health it was R$155,172.64 for FM and R$177,255.93 for leukemias. The patient's journey was divided into ALL (n=9), AML (n=5), SAA (n=5) and Fanconi (n=5). The length of hospital stay (t, in days) was ALL (t=44), AML (t=39), SAA (t=57) and Fanconi (t=36). Care by SUS for each disease: 55% ALL, 50% AML, 80% ASA and 40% Fanconi. Hospital admission initiated by the ward (ENF) 100% ALL, 80% AML, 80% ASA and 100% Fanconi. Of these, 89%, 60%, 80% and 60% respectively, were discharged at the initial unit. No patient was admitted directly to the ICU, but 11% ALL, 20% AML, 20% ASA and 40% Fanconi had a stay in the ICU. Only one patient, with Fanconi anemia, died in the ICU. Conclusions: In SUS, the cost of HSCT in patients with FM was 18% higher than in patients with leukemia. On the other hand, in supplementary health, the average cost of HSCT in patients with leukemia was 14% higher than in patients with FM. These differences are attributed to clinical conditions, ICU demand, and funding methods. Most patients began their hospitalization in the ward, with frequent discharges to the same unit, reflecting efficiency in initial management. Fanconi anemia presented a higher proportion of intensive care unit needs. The analysis highlights the importance of sustainable health strategies to optimize resources and improve the quality of life of pediatric patients undergoing HSCT.
