Unit Cost Analysis of Allogeneic Hematopoietic Stem Cell Transplantation at Dr. Kariadi General Hospital, Semarang, Indonesia.

BACKGROUND

Hematopoietic stem cell transplantation (HSCT) is a curative treatment for hematologic malignancies, yet access in Indonesia remains limited due to high costs and its exclusion from the national health insurance scheme. This study determined the unit cost of allogeneic HSCT at Dr. Kariadi General Hospital using the activity-based costing (ABC) approach.

METHODS

A mixed-method design combined retrospective cost data from three donor-recipient pairs that received HSCT during the January 2023 - December 2024 period and thematic analysis of qualitative interviews with clinical and administrative staff. Costs were categorized as direct and indirect, mapped along the HSCT clinical pathway, and analyzed descriptively.

RESULTS

The total unit cost of allogeneic HSCT was IDR 377,978,399, comprising IDR 297,063,048 for recipients and IDR 80,915,351 for donors. Post-transplant care was the major cost driver among recipients (IDR 157,843,439), while harvesting represented the highest donor-related cost (IDR 37,819,185). However, comparison with current hospital tariffs demonstrated CRRs of 218.8-239.0% for recipients and 113.7-123.6% for donors, suggesting that existing tariff packages exceed the estimated unit costs and may generate a financial surplus.

CONCLUSIONS

The ABC method effectively identified major cost components and financial gaps, highlighting the need for updated reimbursement models and BPJS coverage inclusion to ensure long-term HSCT program sustainability in Indonesia.