How India can steer availability of bone marrow transplant meeting a range of blood therapy needs

M Nagesh Kumar, Managing Director, Celon Labs talks about the accessibility of bone marrow transplants in India

Bone Marrow Transplants (BMTs) are on a steady rise in India, with about 2,500 transplants being performed yearly unlike five years ago when it was less than 500. Though the number of BMT centres is increasing, it is less than 10% of the actual requirement in India. Even today, 90-95 per cent population cannot afford it. Then, how accessible is BMT in India?

Examining the costs involved: Autologous BMT costs about INR 4-7 lakhs while that of a matched related BMT is about INR 11-17 lakhs; unrelated donor BMT and haploidentical BMT costs about INR 21-28 lakhs. Further, depending on the complications, the costs might even go up to INR 52 lakhs. 60% of the costs are incurred towards drugs while blood products cost 5%. Having said that, the generic drug therapy in India is much lower than the rest of the world besides a low consultation fee and overall hospital charges. The good news is that the BMT treatment in India costs only 1/10^th of the costs of BMT in North America, Australia, or Europe.

Examining the suitability of BMT: BMT is a suitable treatment for both cancerous and non-cancerous conditions such as sickle-cell anaemia or thalassemia. Relapse in BMT is less compared to the relapse in chemotherapy and therefore, BMT is a well-preferred treatment for blood cancers. In recent years, haploidentical BMT has been observed to give as good results as a full-matched BMT. With scientific progress and better drugs, India is achieving the current BMT success rates.

Examining the gap between disease prevalence and accessible standardised treatment: A large proportion of patients receiving treatment at government hospitals or institutes that offer subsidised treatment is more in India, according to the Journal of Heamatology (2016). The difference in costs is 50-60% from that of private hospitals.

 How can BMT be made accessible to more and more people then? Here’s more:

 The need to increase the numbers of transplant centres with infrastructure and more and more trained personnel: According to the Journal of American Society for Blood Marrow Transplant (2019), the minimum requirements have been established by the Worldwide Networks for Blood and Marrow Transplantation which are applicable to India as well. Besides the costs involved in setting up a BMT, the sustainability, costs of improvement programmes, the required accreditation, HLA and blood banking; and quality assessments besides well-trained doctors and nurses are essential. Centres like Indian Stem Cell Transplant Registry (ISCTR) () provide a platform to train doctors, technicians, nurses, data management teams and coordinators.

Increasing the donor availability: Only 30 per cent of patients have an HLA-matched sibling or family donor in India. Therefore, large donor registries should be created. Since BMT is not a surgery but involves only changing the blood through the recipient’s arms and transporting it to the bone marrow, creating a donor pool and spreading its awareness will make BMT accessible to people.

Reducing the costs of drugs and making therapy affordable: Cost-effective generic drugs will reduce BMT costs as well – e.g. Melphalan, Cyclophosphamide, Thiotepa, and antifungals used for immunocompromised patients. An INR 500-1000 per injection is affordable for any middle-class family. An ideal-priced therapy should not be over INR  5 lakh as against a dreamy contrast of INR 18-38 lakh slab that a common man is billed with.

A few recommended ways to make BMT more affordable:

• Use of generic drugs.
• An incentive-based approach from the government for more BMT centres, trained medical faculties with a sterile environment for the safety of the patients.
• Insurance and public health schemes must cover the required BMT costs.
• Need more medical centres such as Tata Hospitals that provide free BMT to those below the poverty line.
• Awareness among the masses is a must.
• NGOs must assist needy patients as well.

International medical tourists can afford the costs of BMT in India than in their own respective countries. Undoubtedly, there are quite a few BMT specialised hospitals coming up in recent years, with doctors trained overseas, but they are not enough to meet the requirement. The urgent need is to meet the demand with viable costs. The onus is not only on the government and the hospitals but also on companies that determine the costs of the equipment and life-saving drugs.