How can Cure2Children cut down costs so much without compromising on quality?

Many institutions use expensive drugs, like thiotepa, treosulfan or intravenous busulfan, based on small studies suggesting decreased short-term toxicity in high-risk patients compared to the far less expensive standard oral busulfan which has been used successfully for decades. The use of expensive drugs for high-risk cases is hardly justified when patients can be down-staged into a lower-risk category with aggressive chelation and hydroxyurea therapy. In general, what really makes the difference is how the patient is prepared for BMT rather than the drugs used.
The problem is that too often families are self-referred to transplant centers which do not have the set up for long periods of preparation. This should really be done by thalassemia centers. Moreover, the use of new and more expensive drug combinations like thiotepa and treosulfan, are associated with unknown risks of permanent infertility which may not be the case for the standard combination of oral busulfan with cyclophosphamide.
Many centres do the transplantation for thalassemia within the same setup which has been created keeping in mind the needs of more complicated and higher risk transplantations like those for malignant disorders (cancers). The additional cost of complex air purification systems etc. which are unnecessary for thalassemia transplants get’s added to the transplantation cost inevitably.
Some institutions of course will have substantial overheads and public relations costs which inevitably are borne by patients and their families.

These answers have been prepared by:
- Dr. Lawrence Faulkner, Cure2Children medical team coordinator
- Dr. Sadaf Khalid, Cure2Children Pakistan branch coordinator