日本の小児急性リンパ性白血病における非血縁骨髄移植と非血縁臍帯血移植の直接費用の比較

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  • Comparison of direct costs for allogeneic bone marrow transplantation from unrelated donors and umbilical cord blood transplantation for childhood acute lymphoblastic leukemia in Japan

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Background: The 5-year disease-free survival rate for childhood acute lymphoblastic leukemia has improved due to improvements in the regimen. Hematopoietic stem cell transplantation (HSCT) is performed for patients at very high risk. There are 2 types of HSCT that use bank donors: allogeneic bone marrow transplantation from unrelated donors (U-BMT) and umbilical cord blood transplantation from unrelated donors (U-CBT). We compared the costs of U-BMT and U-CBT. Methods: A standard recipient model was developed based on the publically available clinical path and a literature survey. The period for which costs were calculated was set at 116 days. We analyzed 3 age groups, namely, patients aged 1 to 4 years, 5 to 9 years, and 10 to 14 years. Seven adverse events associated with transplantation were analyzed: severe bacterial infection, severe fungal infection, cytomegalovirus infection, herpes virus infection, graft failure, sinusoidal obstruction syndrome, and acute graft-versus-host disease. Sensitivity analyses were done to confirm the robustness of the calculations. Results: Total cost, including adverse event costs, was 10.3 million yen for U-BMT and 10.9 million yen for U-CBT, and average per diem cost was 87600 yen and 94200 yen, respectively. Sensitivity analysis showed that the total cost of U-CBT was higher than that of U-BMT in all age groups except age group 10 to 14 years. Conclusions: Cost minimization analysis indicated that the total cost of U-CBT, including adverse event costs, for 116 days was 7.4% higher than that of U-BMT. However, recent improvements in U-CBT appear to have substantially reduced the cost of this treatment. 背景:近年,小児期急性リンパ性白血病(acute lymphoblastic leukemia:ALL)の 5 年無病生存率は化学療法の発展により改善された.造血幹細胞移植(hematopoietic stem cell transplantation:HSCT)はリスクの高い患者に施行されている.非血縁ドナーからの移植には,非血縁骨髄移植(allogeneic bone marrow transplantatation from unrelated donors:U-BMT)と非血縁臍帯血移植(umbilical cord blood transplantation from unrelated donors:U-CBT)が行われている.われわれは,U-BMT と U-CBT の移植に要される直接費用を比較検討した.対象と方法:標準患者モデルを公表されたクリニカルパスと文献に基づいて作成した.直接費用の算出期間を移植前処置から退院までの 116 日に設定した.3 つの年齢群(1〜4,5〜9,10〜14 歳)に区分し,分析した.移植中イベントを 7 つ[重症細菌感染症,重症真菌感染,cytomegalovirus(CMV)感染症,ヘルペスウイルス感染症,生着不全,類洞閉塞症候群(sinusoidal obstruction syndrome:SOS),急性移植片対宿主病(acute graft-versus-host disease:aGVHD)]に設定した.解析は感度分析を行った.結果:直接費用は U-BMT 1030 万円,U-CBT 1090 万円であった.1 日あたりの直接費用は,それぞれ 87600円と 94200 円であった.感度分析により,U-BMT が U-CBT よりも高額になる場合が 10〜14 歳の群にのみ認められたが,他の年齢群において U-CBT の直接費用は,U-BMT よりも常に高かった.結論:コスト最小化分析により移植中 116 日間の U-CBT のイベント・コストを含む直接費用は U-BMTより 7.4% 高いことが示唆された.U-CBT の成績の改善は,コスト削減にも関与すると考えられる.

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