BACKGROUND: Transplantation with stem cells from stored umbilical cord blood units is an alternative to living unrelated bone marrow transplantation. The larger the inventory of stored cord units, the greater the likelihood that transplant candidates will match to a unit, but storing units is costly. The authors present the results of a study, commissioned by the Institute of Medicine, as part of a report on the establishment of a national cord blood bank, examining the optimal inventory level. They emphasize the unique challenges of undertaking cost-effectiveness analysis in this field and the contribution of the analysis to policy. METHODS: The authors estimate the likelihood that transplant candidates will match to a living unrelated marrow donor or a cord blood unit as a function of cord blood inventory and then calculate the life-years gained for each transplant type by match level using historical data. They develop a model of the cord blood inventory level to estimate total costs as a function of the number of stored units. RESULTS: The cost per life-year gained associated with increasing inventory from 50,000 to 100,000 units is $44,000 to $86,000 and from 100,000 to 150,000 units is $64,000 to $153,000, depending on the assumption about the degree to which survival rates for cord transplants vary by match quality. CONCLUSION: Expanding the cord blood inventory above current levels is cost-effective by conventional standards. The analysis helped shape the Institute of Medicine's report, but it is difficult to determine the extent to which the analysis influenced subsequent congressional legislation.
BACKGROUND: Transplantation with stem cells from stored umbilical cord blood units is an alternative to living unrelated bone marrow transplantation. The larger the inventory of stored cord units, the greater the likelihood that transplant candidates will match to a unit, but storing units is costly. The authors present the results of a study, commissioned by the Institute of Medicine, as part of a report on the establishment of a national cord blood bank, examining the optimal inventory level. They emphasize the unique challenges of undertaking cost-effectiveness analysis in this field and the contribution of the analysis to policy. METHODS: The authors estimate the likelihood that transplant candidates will match to a living unrelated marrow donor or a cord blood unit as a function of cord blood inventory and then calculate the life-years gained for each transplant type by match level using historical data. They develop a model of the cord blood inventory level to estimate total costs as a function of the number of stored units. RESULTS: The cost per life-year gained associated with increasing inventory from 50,000 to 100,000 units is $44,000 to $86,000 and from 100,000 to 150,000 units is $64,000 to $153,000, depending on the assumption about the degree to which survival rates for cord transplants vary by match quality. CONCLUSION: Expanding the cord blood inventory above current levels is cost-effective by conventional standards. The analysis helped shape the Institute of Medicine's report, but it is difficult to determine the extent to which the analysis influenced subsequent congressional legislation.
Authors: Richard Mitchell; John E Wagner; Claudio G Brunstein; Qing Cao; David H McKenna; Troy C Lund; Michael R Verneris Journal: Biol Blood Marrow Transplant Date: 2014-09-28 Impact factor: 5.742
Authors: Loren Gragert; Mary Eapen; Eric Williams; John Freeman; Stephen Spellman; Robert Baitty; Robert Hartzman; J Douglas Rizzo; Mary Horowitz; Dennis Confer; Martin Maiers Journal: N Engl J Med Date: 2014-07-24 Impact factor: 91.245
Authors: Sergio Querol; Ghulam J Mufti; Steven G E Marsh; Antonio Pagliuca; Ann-Margaret Little; Bronwen E Shaw; Robert Jeffery; Joan Garcia; John M Goldman; J Alejandro Madrigal Journal: Haematologica Date: 2009-02-19 Impact factor: 9.941
Authors: Lawrence D Petz; Istvan Redei; Yvonne Bryson; Donna Regan; Joanne Kurtzberg; Elizabeth Shpall; Jonathan Gutman; Sergio Querol; Pamela Clark; Richard Tonai; Sarah Santos; Aide Bravo; Stephen Spellman; Loren Gragert; John Rossi; Shirley Li; Haitang Li; David Senitzer; John Zaia; Joseph Rosenthal; Stephen Forman; Robert Chow Journal: Biol Blood Marrow Transplant Date: 2012-10-23 Impact factor: 5.742