There is a lot to consider when planning for a bone marrow transplant, and the complex nature of the procedure makes it hard to put a precise figure on the cost of treatment. Many medical professionals are involved in the process, including hematologists, oncologists, radiologists, laboratory technicians, doctors and nurses. Some clinics have dedicated bone marrow transplant teams which focus on the delivery of the treatment from start to finish. A bone marrow transplant also requires the use of state-of-the-art technology and equipment, with new techniques being developed all the time.
With a huge amount of expert resources needed for the treatment to be successful, the cost of a bone marrow transplant can often stretch into hundreds of thousands and many people are unable to get the necessary insurance coverage. If you are considering a bone marrow transplant, there are a number of options available to you. Firstly, you need to consider which type of transplant is most suitable before deciding where you wish to undergo treatment. Whether you are looking to find more affordable treatment or searching for the best specialists in the field, MEDIGO's Guide to Bone Marrow Transplant Cost can help you to make an informed treatment choice.
How does a bone marrow transplant work?
Bone marrow harvesting is usually the first step once the cancer or disease has been identified. This involves the surgical extraction of bone marrow, which is then analysed to assess function and general condition. The most common diseases which affect the bone marrow are leukemias, multiple myelomas and lymphomas.
Once it has been established that cancerous cells are present, a course of chemotherapy begins in an attempt to destroy the cells. In the process, a large number of healthy red and white blood cells will also be damaged. Bone marrow chemotherapy can either be ablative (high dose and intensive) or a "mini transplant" (reduced intensity). Older patients or anyone with underlying health problems are more likely to be given a mini transplant as their body may not be able to cope with high-intensity treatment.
Many bone marrow transplants involve stem cells – early development cells which are able to produce red and white blood cells, as well as platelets. Stem cell transplants in bone marrow are more prevalent as they can be extracted from the blood and not just the bone marrow itself.
There may be some cases, however, where bone marrow is extracted either from another part of your body (autologous) or from a matching donor (allogeneic) and transplanted. If the bone marrow comes from a donor it must closely resemble your own. The majority of bone marrow donations come from a direct sibling, though indirect matches are also able to be transplanted. Donated bone marrow is usually taken from the pelvic area, whilst stem cell donations are extracted directly from the blood. The extraction of the donor material is not dangerous, and 99% of donors are able to return quickly to full health.
Once the donor cells or marrow is ready, the procedure can go ahead. The application of the bone marrow or stem cells can be performed without anesthesia at the patient's bedside using a drip infusion. Over the course of several hours, the material is fed into a centrally located vein, where it then travels to the bone marrow.
Around 2-to-4 weeks after the infusion, the implanted cells will begin to reproduce new red and white blood cells in a process known as engraftment. With the risk of infection high and potentially dangerous, it is possible that you will need to remain in isolation for at least two weeks following the bone marrow transplant. During this time, your blood cell levels will be closely monitored in order to assess whether the infused cells have started to reproduce. On the other hand, stem cell transplants on an outpatient basis are becoming common, with daily hospital visits required (for blood tests) but no need for isolation.
How much does a bone marrow transplant cost?
The final cost of a bone marrow transplant depends upon what type of transplant you are receiving and where you choose to be treated.
Allogeneic transplants – using bone marrow taken from another person – are the most expensive, owing to the additional costs of extracting donor material first. This increased cost also accounts for the test and examinations needed to find a donor match.
Autologous transplants (taken from your own body) are significantly more affordable as this donor material is not required, cutting down on time and resources.
The average cost of an allogeneic bone marrow transplant in the United States is around $800,000, while an autologous transplant will cost you around $350,000. This can vary hugely from state to state, though, and areas where bone marrow transplants are in high-demand will see higher prices. In the case of a child requiring a bone marrow transplant, the cost will range between $75,000 and $200,000.
In the United Kingdom, cases in which a bone marrow transplant is required to save a life are usually covered by the National Health Service, though waiting lists are often long and the chances of obtaining treatment can often depend on a 'postcode lottery'. A bone marrow transplant at a private hospital in the UK will cost anywhere between £300,000 and £750,000.
All final costs for bone marrow treatment should include the following:
- Health check-ups and examinations
- Sourcing and extraction of donor cells (if allogeneic)
- Infusion of new cells
- Blood tests and aftercare
Cost of bone marrow transplant abroad
With the cost of bone marrow transplants in the United Kingdom and the US beyond many people's budgets, more and more patients are choosing to travel abroad for their treatment. Although the idea of travelling to a foreign land for a bone marrow transplant may seem like a scary idea, there are a number of hospitals abroad which specialize in treating cancer patients from across the globe. The majority of patients choose to travel abroad either to cut waiting times or to find a more affordable treatment, while some patients travel to find the best specialists.
A great deal of investment has gone into India's healthcare sector in recent years. There are a number of hospitals across India providing both bone marrow and stem cell transplants at a fraction of the cost compared to the US and Europe. Whilst the cost may be cheaper, the quality of treatment remains high. Many Indian doctors train and gain experience at hospitals around the world and bring their expertise back to India, and a many Indian hospitals are in partnership with American institutions. Bone marrow transplants at MEDIGO-listed clinics in India start from around $10,999.
Turkey is a popular destination for patients from both Europe and the Middle East who are looking for more-affordable bone marrow transplants. Turkish hospitals are renowned for the level of patient care that they offer, and the country is home to some of the world's most-reputable cancer specialists. At MEDIGO clinics in Turkey, the cost of a bone marrow transplants begins at $49,999.
With a reputation as Europe's center of excellence in a number of medical fields, Germany is also able to offer high-quality bone marrow transplants at world-class hospitals. Patients travel from all over the world to be treated by Germany's oncology specialists. The average cost of a bone marrow transplant in Germany is around $225,000.
How long will I need to stay abroad?
Each bone marrow transplant patient will have their own timeline depending on the type and stage of the cancer, the type of transplant they are having, and their overall health. However, the process of receiving bone marrow will always require numerous visits to the clinic or hospital.
Preparation is key to a successful transplant. Once a suitable donor is identified, in the week or two leading up to the transplant you will need to undergo a series of diagnostic tests to assess your overall health and further stage the disease. The next stage is know as conditioning, whereby a course of chemotherapy is administered.
Once conditioning is complete, the transplant can proceed. The most critical stage of the transplant is engraftment. This usually takes between 10 and 30 days. During this time, the implanted cells should begin to grow and the immune system and bone marrow starts to regenerate. Patients in the engraftment stage are at great risk of infection and complications owing to a lack of white blood cells, so you will need to be closely monitored and remain in hospital.
Around 2-3 weeks after the transplant you will be able to leave the hospital and continue your recovery as an outpatient, but you will need to return the hospital for regular follow-ups over the following weeks and months. If you have travelled abroad for a bone marrow transplant, it may be possible to complete your outpatient recovery in your country of residence, providing there is prior agreement and cooperation between your home clinic and the clinic where you receive the transplant.
What is bone marrow and why do I need it?
Bone marrow is a soft tissue at the centre of the bones which contain various capillaries and blood vessels. The main purpose of the bone marrow is the production of new, healthy blood cells for the rest of the body – around 200 billion blood cells every 24 hours. This blood cell production is essential in the maintenance of a healthy and functioning vascular system, as well as a major contributor to the body's lymphatic system.
Two different forms of bone marrow exist: yellow and red. Most of your red and white blood cells are produced in the red marrow whilst fat and cartilage are developed in the yellow marrow. Your red blood cells will live for around 120 days, while white blood cells usually survive for no more than 4 days, making the constant replenishment of cells essential. Healthy cell reproduction is also necessary to successfully fight off disease and infection. Red bone marrow also produces platelets, which form blood clots to prevent excessive bleeding and which help the body to bruise properly. Similarly, the production of hemoglobin in red blood cells is vital for respiration, collecting oxygen and disposing of carbon dioxide.
There are a number of diseases that affect the ability of the bone marrow to work efficiently, leading to a range of complications. The most common diseases that affect the bone marrow are cancers such as leukemia and lymphoma, as well as conditions like sickle cell anemia and tuberculosis. Bone marrow treatment often involves the application of high-intensity chemotherapy for cancer, which further damages the bone marrow and its ability to produce cells. This often means that a bone marrow transplant is the only remaining option.
What are the possible complications?
The most common issue following a bone marrow transplant is infection. With the red and white blood cells yet to develop in the weeks immediately after the infusion, the chance of infection becomes both higher and potentially life-threatening. Remaining in isolation and ensuring that you avoid anyone who is sick or can transmit an infection is very important during this period.
There is always a chance that the donated cells or bone marrow will clash with the host cells already present, resulting in a condition called 'graft versus host disease' (GVHD). If the condition is not picked up and treated, it can lead to liver disease and various gastrointestinal illnesses. Blood transfusions can be given to counter the condition. Increasingly, autologous transplants are being used for bone marrow procedures, which help avoid the chance of GVHD developing.
Can I donate bone marrow?
Anyone can join the bone marrow donation registry, providing they meet a range of criteria. Donors must be in reasonably good health and between the ages of 18 and 60, be free of infection, and pass a full medical examination prior to donating. Those who are not able to donate include pregnant women, substance abusers, carriers of hepatitis, cancer sufferers, or those with existing heart conditions.
Once you are in bone marrow donation registry, your bone marrow characteristics are added to the database and you will be called to donate when a suitable match requires a transplant.
Bone Marrow Transplant Resources
- Patient stories -The Bone Marrow Foundation
- Matching patients with donors – Be The Match
- Real stories – Anthony Nolan
- Center for International Bone Marrow Transplant Registry