Monday, April 2, 2007

BMT Breakdown by NUH-Singapore

This is from Zin Mar, Paediatrics Blood/Marrow Transplant Coordinator of the Paediatrics Department of National University Hospital, Singapore.

Please see below for detailed explanation on BMT cost and procedures.
However, Nichi will have to be on chemotherapy till remission before the bone marrow transplant. This will incur additional cost. I'll not be able to give you the figure. Drs need to assess him and decide on which regime he needs to be on.

(A) Initial Medical Consultation – Duration 1-day

For Patient
First consult, to determine
1. Suitability of patient and donor/s for BMT.
2. Schedule of BMT.
3. Meet with BMT nurse clinician/ coordinator (BMT NC)

If donor identified and confirmed, subsequent consults with physician and BMT NC will be required at 1 – 3 monthly intervals (3 days).

Selection of donors (at first consult)
1. HLA typing of all unaffected siblings (results available in 14 days)
2. If no sib match, unrelated donor search international registries for umbilical cord blood and adult donors (results available in 4 weeks)
HLA typing for patient and parent's cost about S$2000. Each sibling's HLA typing cost about S$ 550 (HLA A, B and DR Low resolution). If there's a match with one of the siblings, we'll do high resolution for the match donor, which will cost additional S$550.
However, if there's no match with any siblings, we'll have to search for donor or umbilical cord blood.

(B) Preparation of patient for BMT - Duration 3-days

1. Review, work-up, preparation starts 3 months before actual BMT (clinical examination, blood tests, medications)
2. Informed consent.
3. Confirmation of procurement of unrelated stem cell graft (if applicable)
(Procurement fees can range from $40,000 - $80,000)
4. BMT Nurse Clinician counselling.

(C) Preparation of sibling donor for BM donation – Duration 3-days

1. First review, work-up starts 3 months before actual BMT (clinical examination, blood tests)
2. Second review, work-up 1 month before BMT (clinical examination, blood tests)

(D) Patient’s Pre & admission for BMT – Duration 40 to 80 days

1. Review of patient 2 weeks before admission for BMT
2. Average duration of stay for BMT – 40 to 80 days

(E) Donor’s pre/ post and admission for BM donation – Duration 21 to 28 days

1. Review of donor 2 weeks before admission for BM donation
2. Bone Marrow Harvesting - Average duration of stay for procedure – 3-days
3. Review of donor 1 month after BM donation (1-day)

(F) Post-BMT follow-up for patient

1. Twice weekly follow-up to Day+100 of BMT, then weekly x 4 – 8 weeks, then monthly x 6 – 12 months
2. Return to home country allowed 6 – 12 months after BMT depending on complications

(G) Estimated Cost

The estimated costs for Blood & Marrow Transplantation (BMT) is about SGD$150,000++. It is an estimated costs for the transplant admit, laboratory tests during admission and medications. These charges do not include outpatient pharmacy, housing, transportation cost.

*Cost estimated serves only as a guide and it is not exhaustive.
*Cost may vary due to complications.

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