Redesigning care in India to reduce the cost of bone marrow transplants

Bone Marrow Transplant
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Over the last few years, remarkable advancements in medical science and technology have resulted in a rise in the success rate of bone marrow transplants and improved survival rates for various forms of blood malignancies.

A bone marrow transplant involves the transplantation of healthy blood stem cells into the bone marrow to replace the affected cells or cells that have been killed in the bone marrow. 

The red blood cells, platelets, and white blood cells are made anew to help your body fight infections and issues like anemia. The stem cells that are transplanted into your body may come from your own body or that of a donor.  

While bone marrow transplant cost in India is relatively lower, they are still expensive, and growing scrutiny of cancer treatment costs has led to the implementation of episode-based reimbursement by health insurance companies. 

The key drivers of bone marrow transplant cost in India last from 30 days before transplant to 60-100 days after transplant. Understanding the major cost drivers in BMT (Bone Marrow Transplant) episodes is one of the goals.

The cost categories usually are room accommodations, medicines, medical and surgical supplies, imaging, and labs to map expenses of BMT episodes, covering pre-transplant, transplant (index), and post-transplant phases of care.

How is Patient Care being redesigned for lower-cost Bone Marrow Transplants in India?

Many ideas are proposed and undertaken to reshape care to safely transition from inpatient to outpatient treatment while also ensuring lower cost of bone marrow transplants. Specific topics for improvement are explored and rated based on importance and internal evaluations. The following are the most common ones that are being applied:

  1. Accurate Assessment tools
  • To improve the quality and efficiency of clinical data capture and analysis at the treatment center, the BMT program purchased high-grade BMT informatics software.
  • To reduce error rates and improve retention, the goal should focus on practical training.
  • A BMT program’s data abstraction accuracy is crucial. 
  • It was possible to obtain and maintain an overall accuracy rate of better than 97 percent by assembling a multidisciplinary team to do a root cause analysis and build a complete response plan.

2. Patient Care and Education:

  • Having a team of medical specialists to deal with low patient satisfaction due to discharge unpreparedness and a lack of preparation at home.
  • Patient safety, institutional goals, and patient and staff happiness can all be impacted by providing appropriate and timely education to patients and their families.
  • Obtaining specialist certification for medical practitioners can authenticate specialized knowledge, provide personal success, and demonstrate professional advancement. An example is Bone Marrow Transplant Certified Nurse Certification. 
  • Transplant recipients require special attention due to the long-term physical, social, psychological, and spiritual impacts of SCT, which affect their quality of life and ability to reintegrate into their personal and social lives.
  • Pediatric patients who spent at least six hours out of bed each day had a higher degree of functioning. One can utilize this data to develop out-of-bed activity regimens for these patients.
  1. Medication Sensitivity
  • Plerixafor was initially given 11 hours before apheresis for hematopoietic stem cell mobilization, based on a peak impact of 10-14 hours. 
  • Because of post-plerixafor anaphylactic events, FDA reports show that plerixafor activity can last up to 18 hours.
  • When administered before highly emetogenic, single-day regimens, olanzapine has shown potential in preventing chemotherapy-induced nausea and vomiting (CINV). One of the most dreaded problems of patients is uncontrolled CINV, which can lead to complications and an extended stay in the hospital.
  • Chemotherapy dosage guidelines are there for obese individuals. The recommendation is that melphalan (MEL) be administered based on the Actual Body Weight (ABW) in the body surface area calculation.
  • Vitamin D has a significant impact on bone health. Vitamin D deficiency before the transplant has been linked to a lower risk of chronic graft versus host illness and a lower risk of CMV infection after the transplant. According to recent research, vitamin D may play a role in immunological tolerance following a transplant.
  • Following allogeneic hematopoietic stem cell transplantation (ASCT), effective GvHD prevention is critical for decreasing treatment-related morbidity and mortality.


Patient education is multifaceted and requires collaboration across disciplines and the treatment continuum. Goals like increasing patient satisfaction in discharge preparedness and improving employee involvement in terms of overall satisfaction increase the chances of caring for oneself at home. 

This reduces readmission rates and expenses and needless discharge delays, which is the long-term aim. A well-trained workforce results in a better working environment, higher success rates, fewer audits, and higher overall satisfaction. 
All of this leads to reduced turnover that saves money for the patient and the institution and keeps in check the already lower bone marrow transplant cost in India.

Shikha Dhawan

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