High costs deter patients from going for bone marrow transplant in Karnataka

Bone marrow transplant (BMT) is a life-saving procedure for many patients with blood cancers and blood disorders, but high costs prevent the majority from using it.

In BMT, the patient receives healthy stem cells either from their own body (autologous transplant) or from a donor (allogenic transplant). The cost of an allogeneic transplant from an unrelated donor is Rs 15-20 lakh even in government hospitals and can go up to Rs 35 lakh in the private sector. Autologous transplants cost up to Rs 8 lakh in the private sector.

Follow-up care after transplant costs around Rs one lakh per month, and much more in case of complications.

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At Ramaiah Medical College, 60-65% of eligible patients are unable to undergo the procedure, mainly due to cost, says paediatric haematologist Dr Rasmi Palassery. “A small percentage also becomes ineligible due to complications, or defer treatment for other reasons. But the cost is the commonest factor.”

The proportion is around the same at the Kidwai Memorial Institute of Oncology. The hospital, which started its BMT unit about a year ago, gets nearly 100 patients eligible for BMT annually. The unit has completed 27 procedures so far.

These were mostly autologous transplants that cost Rs 2.5-5 lakh. “Patients get Rs 3 lakh from the PM’s National Relief Fund, which is often sufficient for autologous transplants,” says Dr Linu Jacob, Medical Oncology HOD at Kidwai. Very few can afford the high costs of allogenic transplants.

In conditions like relapsed acute leukaemia and severe aplastic anaemia, the patient may not survive long without BMT, doctors say.

St John’s Medical College Hospital gets 300-400 eligible patients annually. Of them, only 30% can find a matching donor, and only 15% undergo the procedure. Finding an unrelated matching donor involves a cost of Rs 8 lakh, said Dr Cecil Ross, head of the Haematology Department.

In corporate hospitals that see financially better-off clientele, the uptake is better. Still, at Manipal Hospitals, 10-15% of patients cannot afford the treatment, says BMT consultant Dr Ashish Dixit.

At Sparsh Hospital, BMT physician Dr Sunil Udgire says that around 50% find the procedure unaffordable. At HCG, most patients undergo the procedure but borrow large sums, causing long-term financial distress, says Dr Sachin Jadhav, Group Head-Haematology and Stem Cell Transplant.

Paltry coverage from govt schemes

Currently, most patients in Karnataka get Rs 3 lakh from the PM’s relief fund. Response from the CM’s relief fund varies and depends on the patient’s connections, doctors say. Crowdfunding and private health insurance coverage have limitations.

Doctors point out that Tamil Nadu, Andhra Pradesh and Assam offer coverage for BMT in the range of Rs 11-17 lakh. Karnataka does not provide coverage for the general population. It recently passed an order to provide coverage of Rs 7-21 lakh for SC/ST patients, and this is yet to start.