Funding model for stem cell transplant.
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22 Background: A call for development of a new model for funding Stem Cell Transplant (SCT) services in Ontario led to a costing initiative described below. The new model needed to be in alignment with current costs and clinical practices, and to avoid over or under-funding the required components of care for all types of transplant (autologous, allogeneic-related, allogeneic un-related). Methods: The patient care path was broken down by transplant type into the following phases: Pre-Transplant, Graft Harvesting or Procurement, Transplant, and Follow-Up. The following Canadian and Ontario data sources were used for fiscal year 2013/14 and 2014/15 to identify costs of care: -Case Costing data submitted by the six hospitals providing SCT services, -Discharge Abstract Database (DAD), -National Ambulatory Care Reporting System (NACRS), -Other data sources, as needed (e.g. Specialized Services Oversight Information System, Health Indicator Tool). Additionally, the costs for high cost drugs, infrastructure, psychosocial support, and pathology services components were specifically identified. Broad consultation with clinical, administrative, and costing experts ensured the data was complete and appropriate to patient care needs. Once the costs for each component and phase were estimated, the funding model was developed using the bundling approach where the costs of specific activities and/or phases were bundled together for the purposes of funding. Results: The SCT Funding Model developed based on this costing initiative consists of the following four bundles covering the continuum of a patient’s care from pre-transplant to post-transplant care follow-up: 1.) Pre-Transplant, 2.)Graft Acquisition, 3.)Transplant (includes transplant and follow-up), and 4.) High Cost Drugs. Conclusions: The new SCT Funding Model reflects up-to-date costs and addresses the gaps of the previous approach. It has been implemented and is widely supported due to the extensive stakeholder engagement throughout the process. It is an important component of provincial-level planning for SCT service delivery.
