Introduction: Hematopoietic stem cell transplantation (HSCT) is a highly specialized procedure, in perpetual progress and requiring significant resources. In Tunisia, the National Health Insurance Fund (CNAM) allocated in 1996, a budget that has never been updated since.

Objective: Assessment of the direct costs of allogeneic HSCT during the first year post-transplantation, in order to enable authorities revising the reimbursing budget allocated by the CNAM.

Methods: We conducted a medico-economic study according to the method Activity Based costing (ABC). The costs of drugs, biochemical assessments, transfusions, hospitalizations and medical devices have been classified and estimated over 3 periods: pre-transplant, transplant hospitalization and post-transplant, for an adult patient during 1 year follow-up. Health care costs were obtained from orders forms and by the hospital administration.

Results: The average direct cost of an allograft HSCT of adult patient during the first year in 2020 was 51 198 € vs 24 898 € in 1996. Hospitalization for transplantation was the most expensive (60% of total direct costs), followed by the post-transplant period (33%) and the pre-transplant period (7%). During hospitalization, drugs accounted for the largest share (60%) of the costs, mainly for conditioning / chemotherapy drugs (8 769 €) and management of febrile neutropenia (7 835 €). The mean cost of hospitalization was 8 207 € for an average stay of 45 days.Regarding post-transplant period, the most expensive complication was Graft-vs-Host Disease (GVH) with positive Cytomegalovirus (CMV) (23 930 €) followed by CMV reactivation (17 893 €), GVH without CMV (9 029 €) and evolution without complication (3 522 €). During the pre-transplant period, the cost of mobilization with growth factors represented the largest expense (54%).

Conclusion: Considering the important increasing of the direct costs since 1996 (24 898€ in 1996 to 51 198€ in 2020), a new agreement with the CNAM is crucial.