Skip to main content

Advertisement

SpringerLink
Log in

Cost of Treatment of Multiple Myeloma in a Public Sector Tertiary Care Hospital of North India

  • Original Article
  • Published:
Indian Journal of Hematology and Blood Transfusion Aims and scope Submit manuscript

Abstract

Multiple myeloma (MM) is a neoplastic disorder, which accounts for 13% of all hematological malignancies globally. While, conventional chemotherapy used to be the mainstay treatment for the disease, the landscape of treatment witnessed a paradigm shift with the introduction of high-dose chemotherapy and autologous stem cell transplant (ASCT). In this paper, we present a cost analysis of various services provided to multiple myeloma patients, using either of the two modalities of treatments i.e. conventional chemotherapy or ASCT. Bottom-up costing methodology was used to collect data on all health system resources, i.e. capital or recurrent, which were used to provide various services to MM patients. Capital costs were annualized for their useful life using a discount rate of 5%. Out of pocket expenditure on treatment was also ascertained. Cost was assessed for various services, including outpatient consultation, bed day hospitalization in general ward, high dependency unit intensive care setting and bone marrow transplant unit. Unit costs were calculated from both health system and patient perspective. The overall cost per patient for ASCT (including high dose chemotherapy) and conventional chemotherapy from societal perspective was INR 395,527 (USD 6085) and INR 62,785 (USD 966) respectively. Estimates on cost from our study could be used for planning health services, and evaluating cost effectiveness of different modalities of care for multiple myeloma.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Fitzmaurice C, Dicker D, Pain A, Hamavid H, Moradi-Lakeh M, MacIntyre M et al (2015) The global burden of cancer 2013. JAMA Oncol 1(4):505–527

    Article  PubMed  Google Scholar 

  2. Takiar R, Nadayil D, Nandakumar A (2010) Projections of number of cancer cases in India (2010–2020) by cancer groups. Asian Pac J Cancer Prev 11:1045–1049

    PubMed  Google Scholar 

  3. Raab M, Podar K, Breitkreutz I, Richardson P, Anderson K (2009) Multiple myeloma. Lancet 374:324–339

    Article  PubMed  Google Scholar 

  4. Ghalaut P, Chaudhuri S, Singh R (2013) Recent advances in diagnosis and management of multiple myeloma: an update. The Association of Physicians of India, Medicine Update, India

    Google Scholar 

  5. Lu J, Hou J, Liu KY, Parmar S, De La Fuente A, Andersson B et al (2016) Asia-Pacific Hematology Consortium Report on approach to multiple myeloma. Survey results from the 6th international hematologic malignancies conference: bridging the gap 2015, Beijing, China. Leuk Lymphoma 57(7):1534–1538

    Article  PubMed  Google Scholar 

  6. Yanamandra U, Khattry N, Kumar S, Raje N, Jain A, Jagannath S et al (2017) Consensus in the management of multiple myeloma in India at myeloma state of the art 2016 conference. Indian J Hematol Blood transfus 33(1):15–21

    Article  PubMed  Google Scholar 

  7. Barlogie B, Hall R, Zander A, Dicke K, Alexanian R (1986) High-dose melphalan with autologous bone marrow transplantation for multiple myeloma. Blood 67(5):1298–1301

    CAS  PubMed  Google Scholar 

  8. Fermand JP, Chevret S, Ravaud P, Divine M, Leblond V, Dreyfus F et al (1993) High-dose chemoradiotherapy and autologous blood stem cell transplantation in multiple myeloma: results of a phase II trial involving 63 patients. Blood 82(7):2005–2009

    CAS  PubMed  Google Scholar 

  9. Cunningham D, Paz-Ares L, Milan S, Powles R, Nicolson M, Hickish T et al (1994) High-dose melphalan and autologous bone marrow transplantation as consolidation in previously untreated myeloma. J Clin Oncol 12(4):759–763

    Article  CAS  PubMed  Google Scholar 

  10. Harousseau JL, Attal M, Divine M, Marit G, Leblond V, Stoppa AM et al (1995) Autologous stem cell transplantation after first remission induction treatment in multiple myeloma: a report of the French Registry on autologous transplantation in multiple myeloma. Blood 85(11):3077–3085

    CAS  PubMed  Google Scholar 

  11. Attal M, Harousseau JL, Stoppa AM, Sotto JJ, Fuzibet JG, Rossi JF et al (1996) A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. Intergroupe Francais Du Myelome. N Engl J Med 335(2):91–97

    Article  CAS  PubMed  Google Scholar 

  12. Child JA, Morgan GJ, Davies FE, Owen RG, Bell SE, Hawkins K et al (2003) High-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma. N Engl J Med 348(19):1875–1883

    Article  CAS  PubMed  Google Scholar 

  13. Kumar L, Raju GM, Ganessan K, Shawgi S, Menon H, Wadhwa J et al (2003) High dose chemotherapy followed by autologous haemopoietic stem cell transplant in multiple myeloma. Natl Med J India 16(1):16–21

    PubMed  Google Scholar 

  14. Koreth J, Cutler CS, Djulbegovic B, Behl R, Schlossman RL, Munshi NC et al (2007) High-dose therapy with single autologous transplantation versus chemotherapy for newly diagnosed multiple myeloma: a systematic review and meta-analysis of randomized controlled trials. Biol Blood Marrow Transplant 13(2):183–196

    Article  CAS  PubMed  Google Scholar 

  15. Kumar L, Ghosh J, Ganessan P, Gupta A, Hariprasad R, Kochupillai V (2009) High-dose chemotherapy with autologous stem cell transplantation for multiple myeloma: what predicts the outcome? Experience from a developing country. Bone Marrow Transplant 43(6):481–489

    Article  CAS  PubMed  Google Scholar 

  16. Prinja S, Kaur G, Malhotra P, Jyani G, Ramachandran R, Bahuguna P et al (2017) Cost-effectiveness of autologous stem cell treatment as compared to conventional chemotherapy for treatment of multiple myeloma in India. Indian J Hematol Blood Transfus. doi:10.1007/s12288-017-0776-1

    PubMed  Google Scholar 

  17. Prinja S, Jagnoor J, Chauhan AS, Aggarwal S, Nguyen H, Ivers R (2016) Economic burden of hospitalization due to injuries in North India: a cohort study. Int J Environ Res Public Health. doi:10.3390/ijerph13070673

    PubMed  PubMed Central  Google Scholar 

  18. Hendriks ME, Kundu P, Boers AC, Bolarinwa OA, Te Pas MJ, Akande TM et al (2014) Step-by-step guideline for disease-specific costing studies in low- and middle-income countries: a mixed methodology. Global Health Action 7:23573

    Article  PubMed  Google Scholar 

  19. Beck EJ, Harling G, Gerbase S, DeLay P (2010) The cost of treatment and care for people living with HIV infection: implications of published studies, 1999–2008. Curr Opin HIV AIDS 5(3):215–224

    Article  PubMed  Google Scholar 

  20. Adam T, Bishai D, Khan M, Evans D (2004) Methods for the costing component of multi-country evaluation of IMNCI. World Health Organization, Geneva

    Google Scholar 

  21. Prinja S, Jeet G, Verma R, Kumar D, Bahuguna P, Kaur M et al (2014) Economic analysis of delivering primary health care services through community health workers in 3 North Indian states. PLoS ONE 9(3):e91781

    Article  PubMed  PubMed Central  Google Scholar 

  22. Prinja S, Mazumder S, Taneja S, Bahuguna P, Bhandari N, Mohan P et al (2013) Cost of delivering child health care through community level health workers: how much extra does IMNCI program cost? J Trop Pediatr 59(6):489–495

    Article  PubMed  Google Scholar 

  23. Prinja S, Manchanda N, Mohan P, Gupta G, Sethy G, Sen A et al (2013) Cost of neonatal intensive care delivered through district level public hospitals in India. Indian Pediatr 50(9):839–846

    Article  PubMed  Google Scholar 

  24. Prinja S, Gupta A, Verma R, Bahuguna P, Kumar D, Kaur M et al (2016) Cost of delivering health care services in public sector primary and community health centres in North India. PLoS ONE 11(8):e0160986

    Article  PubMed  PubMed Central  Google Scholar 

  25. Prinja S, Bahuguna P, Gupta R, Sharma A, Rana SK, Kumar R (2015) Coverage and financial risk protection for institutional delivery: how universal is provision of maternal health care in India? PLoS ONE 10(9):e0137315

    Article  PubMed  PubMed Central  Google Scholar 

  26. Gupta I, Chowdhury S, Prinja S, Trivedi M (2016) Out-of-pocket spending on out-patient care in India: assessment and options based on results from a district level Survey. PLoS ONE 11(11):e0166775

    Article  PubMed  PubMed Central  Google Scholar 

  27. Prinja S, Gupta R, Bahuguna P, Sharma A, Kumar Aggarwal A, Phogat A et al (2017) A composite indicator to measure universal health care coverage in India: way forward for post-2015 health system performance monitoring framework. Health Policy Plan 32(1):43–56

    Article  PubMed  Google Scholar 

  28. ISPOR (2016) Pharmacoeconomics and outcomes research guidelines for India PEOR Guidelines 2016. https://www.ispor.org/consortiums/asia/PEGuidelines_India_March2016.pdf

  29. Sangwan A, Prinja S, Aggarwal S, Jagnoor J, Bahuguna P, Ivers R. Cost of trauma care in secondary and tertiary care public sector hospitals in north India. Appl Health Eco Health Policy. 2017. doi:10.1007/s40258-017-0329-7

    Google Scholar 

  30. The Economic Times (2015) Forex rates 2015. http://economictimes.indiatimes.com/markets/forex

  31. Mishra V, Andresen S, Brinch L, Kvaloy S, Ernst P, Lonset MK et al (2005) Cost of autologous peripheral blood stem cell transplantation: the Norwegian experience from a multicenter cost study. Bone Marrow Transplant 35(12):1149–1153

    Article  CAS  PubMed  Google Scholar 

  32. Sharma SK, Choudhary D, Gupta N, Dhamija M, Khandelwal V, Kharya G et al (2014) Cost of hematopoietic stem cell transplantation in India. Mediterr J Hematol Infect Dis 6(1):e2014046

    Article  PubMed  PubMed Central  Google Scholar 

  33. Mukhopadhyay A, Gupta P, Basak J, Chakraborty A, Bhattacharyya D, Mukhopadhyay S et al (2012) Stem cell transplant: an experience from eastern India. Indian J Med Paediatr Oncol 33(4):203–209

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Garg CC, Karan AK (2009) Reducing out-of-pocket expenditures to reduce poverty: a disaggregated analysis at rural–urban and state level in India. Health Policy Plan 24(2):116–128

    Article  PubMed  Google Scholar 

  35. Bhojani U, Thriveni B, Devadasan R, Munegowda C, Devadasan N, Kolsteren P et al (2012) Out-of-pocket healthcare payments on chronic conditions impoverish urban poor in Bangalore, India. BMC Public Health 12:990

    Article  PubMed  PubMed Central  Google Scholar 

  36. NSSO (2015) Key indicators of social consumption in India Health NSS 71st Round (January–June 2014). Ministry of Statistical and Programme Implementation, New Delhi

Download references

Author information

Authors and Affiliations

  1. School of Public Health, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India

    Gunjeet Kaur & Shankar Prinja

  2. Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Pankaj Malhotra, Deepesh P. Lad, Gaurav Prakash, Alka Khadwal & Subhash Varma

  3. Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Raja Ramachandran

Authors
  1. Gunjeet Kaur
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shankar Prinja
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pankaj Malhotra
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Deepesh P. Lad
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gaurav Prakash
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alka Khadwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Raja Ramachandran
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Subhash Varma
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shankar Prinja.

Ethics declarations

Conflict of interest

None.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 89 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kaur, G., Prinja, S., Malhotra, P. et al. Cost of Treatment of Multiple Myeloma in a Public Sector Tertiary Care Hospital of North India. Indian J Hematol Blood Transfus 34, 25–31 (2018). https://doi.org/10.1007/s12288-017-0843-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12288-017-0843-7

Keywords

Search

Navigation