Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Allografting

Financial burden of national health insurance for treating patients with transfusion-dependent thalassemia in Taiwan

Bone Marrow Transplantation volume 37, pages 569–574 (2006)Cite this article

Abstract

The thalassemias are a heterogeneous group of inherited hypochromic anemias of varying severity. The mainstay of supportive treatment is regular blood transfusion accompanied by iron-chelating therapy. Hematopoietic stem cell transplantation (HSCT) provides an alternative option when curative therapy is considered. More than 400 patients in Taiwan have β-thalassemia major or other transfusion-dependent thalassemias, and their treatment costs account for a considerable percentage of the National Health Insurance expenditure. In this report, we estimated the treatment costs of conventional therapy (regular blood transfusion accompanied by iron-chelating agents) and HSCT. The undiscounted medical cost of 20 years of follow-up (20 years from diagnosis) and the undiscounted total lifetime cost were NT$ 4 739 888 (NT$ means New Taiwan Dollars)/US$ 149 288 and NT$ 11 529 990/US$ 363 149, respectively, for patients undergoing conventional therapy, and NT$ 2 639 982/US$ 83 149 and NT$ 3 511 172/US$ 110 588, respectively, for those undergoing successful HSCT. Comparisons of treatment costs and other parameters between these two modalities can add to the information base on which policy is made by health authorities or clinicians.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Rund D, Rachmilewitz E . New trends in the treatment of beta-thalassemia. Crit Rev Oncol Hematol 2000; 33: 105–118.

    Article  CAS  Google Scholar 

  2. Lawson SE, Roberts IA, Amrolia P, Dokal I, Szydlo R, Darbyshire PJ . Bone marrow transplantation for beta-thalassemia major: the UK experience in two paediatric centres. Br J Hematol 2003; 120: 289–295.

    Article  Google Scholar 

  3. Modell B, Khan M, Darlison M . Survival in beta-thalassemia major in the UK: data from the UK thalassemia register. Lancet 2000; 355: 2051–2052.

    Article  CAS  Google Scholar 

  4. Wonke B . Clinical management of beta-thalassemia major. Semin Hematol 2001; 38: 350–359.

    Article  CAS  Google Scholar 

  5. Karnon J, Zeuner D, Brown J, Ades AE, Wonke B, Modell B . Lifetime treatment cost of beta-thalassemia major. Clin Lab Haematol 1999; 21: 377–385.

    Article  CAS  Google Scholar 

  6. Ginsberg G, Tulchinsky T, Filon D, Goldfarb A, Abramov L, Rachmilevitz EA . Cost-benefit analysis of a national thalassaemia prevention programme in Israel. J Med Screen 1998; 5: 120–126.

    Article  CAS  Google Scholar 

  7. Lin KH . Pediatric hematopoietic stem cell transplantation in Taiwan. Transplant Proc 1998; 30: 3477–3480.

    Article  CAS  Google Scholar 

  8. Borgna-Pignatti C, De Rugolotto SSP, Di Piga AGF, Gamberini MR, Sabato V, Melevendi C et al. Survival and disease complications in thalassemia major. Ann NY Acad Sci 1998; 850: 227–231.

    Article  CAS  Google Scholar 

  9. Olivieri NF . The beta-thalassemias (published erratum appears in new England journal of medicine 1999, 341, 1407). N Engl J Med 1999; 341: 99–109.

    Article  CAS  Google Scholar 

  10. Hwang JS, Wang JD . Monte carlo estimation of extrapolation of quality-adjusted survival for follow-up studies. Statist Med 1999; 18: 1627–1640.

    Article  CAS  Google Scholar 

  11. Piga A, Longo F, Consolati A . Mortality and morbidity in thalassemia with conventional treatment. Bone Marrow Transplant 1997; 19: 11–13.

    Google Scholar 

  12. Galimberti M, Lucarelli G, Polchi P . HLA-mismatched bone marrow transplantation in thalassemia. Bone Marrow Transplant 1991; 7 (S7): 98–100.

    PubMed  Google Scholar 

  13. Sullivan KM, Anasetti C, Horowitz M, Rowlings PA, Petersdorf EW, Martin PJ et al. Unrelated and HLA-nonidentical related donor marrow transplantation for thalassemia and leukemia. Ann NY Acad Sci 1998; 850: 312–324.

    Article  CAS  Google Scholar 

  14. Contu L, La Nasa G, Arras M, Ledda A, Pizzati A, Vacca A et al. Successful unrelated bone marrow transplantation in beta-thalassemia. Bone Marrow Transplant 1994; 13: 329–331.

    CAS  Google Scholar 

  15. Mentzer WC, Cowan MJ . Bone marrow transplantation for beta-thalassemia: the university of California San Francisco experience. J Pediatr Hematol/Oncol 2000; 22: 598–601.

    Article  CAS  Google Scholar 

  16. Issaragrisil S, Visuthisakchai S, Suvatte V, Tanphaichitr VS, Chandanayingyong D, Schreiner T et al. Transplantation of cord blood stem cells into a patient with severe thalassemia. N Engl J Med 1995; 332: 367–369.

    Article  CAS  Google Scholar 

  17. Kelly P, Kurtzberg J, Vichinsky E, Lubin B . Umbilical cord blood stem cells: application for the treatment of patients with hemoglobinopathies. J Pediatr 1997; 130: 695–703.

    Article  CAS  Google Scholar 

  18. Miniero R, Rocha V, Saracco P, Locatelli F, Brichard B, Nagler A et al. Cord blood transplantation (CBT) in hemoglobinopathies. Bone Marrow Transplant 1998; 22 (S1): S78–S79.

    PubMed  Google Scholar 

  19. Roberts IAG, Darbyshire PJ, Will AM . BMT for children with thalassemia major in the UK. Bone Marrow Transplant 1997; 19: 60–61.

    Google Scholar 

  20. Cappellini MD . Iron-chelating therapy with the new oral agent ICL670 (Exjade®). Best Pract Res Clin Haematol 2005; 18: 289–298.

    Article  CAS  Google Scholar 

  21. Mourad FH, Hoffbrand AV, Sheikh-Taha M, Koussa S, Khoriaty AI, Taher A . Comparison between desferrioxamine and combined therapy with desferrioxamine and deferiprone in iron overloaded thalassaemia patients. Br J Haematol 2003; 121: 187–189.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank Ms Cheng-Fen Yu for her statistical help. This project was partially supported by the National Health Research Institutes No.NHRI-EX94-9204PP.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan

    W-L Ho

  2. Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan

    W-L Ho, K-H Lin, D-T Lin, S-T Jou & M-Y Lu

  3. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

    J-D Wang

  4. Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan

    J-D Wang & C-W Chung

  5. Institute of Statistical Science, Academia Sinica, Taipei, Taiwan

    J-S Hwang

  6. Department of Medicine, Department of Health, Tao-Yuan General Hospital, Tao-Yuan, Taiwan

    J P S Chern

Authors
  1. W-L Ho
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K-H Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J-D Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J-S Hwang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C-W Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D-T Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S-T Jou
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. M-Y Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. J P S Chern
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K-H Lin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ho, WL., Lin, KH., Wang, JD. et al. Financial burden of national health insurance for treating patients with transfusion-dependent thalassemia in Taiwan. Bone Marrow Transplant 37, 569–574 (2006). https://doi.org/10.1038/sj.bmt.1705287

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1705287

Keywords

This article is cited by

Search

Advanced search

Quick links