Cord Blood Establishing a National Hematopoietic Stem Cell Bank Program (2005) / Chapter Skim
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6 Inventory of a National Cord Blood Stem Cell Bank Program
6 Inventory of a National Cord Blood Stem Cell Bank Program
Pages 120-128
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From page 120... ...
When the question of inventory size is viewed through an economic lens, principles of both efficiency and equity should be considered. Efficiency requires that the inventory of a national cord blood stem cell bank program balance the benefits of storing additional units to enhance the length and quality of life of patients against the costs.
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From page 121... ...
These results should be reported routinely to the proposed national oversight board to inform decision making about the tradeoffs between equity and efficiency in the proposed National Cord Blood Bank Program. The inventory should consist of cord blood units that meet consistent standards for regulatory compliance and thus ensure that clinical transplant physicians are confident of the quality of those units used for clinical transplantation.
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From page 122... ...
, rather than this committee. The total number of units needed for the National Cord Blood Stem Cell Bank Program is a policy decision that will have to be made by the governance of the program after the goals of the program are set and after it is ascertained how much money can be allocated toward inventory expansion.
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From page 123... ...
However, as noted in Chapter 1, the attrition rate of those marrow donors is very high, and a potential match in the adult donor database does not mean the immediate availability of a graft source. If the cord blood inventory is increased to 300,000 units, the likelihood of finding a match of either cord blood or bone marrow remains the same, but the likelihood of finding a cord blood match increases to 17 percent.
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From page 124... ...
The level of HLA match required, the cell dose, and the particular interplay between these two measures are under constant scrutiny by transplant physicians and banks. Using data provided by the New York Blood Center, the National Marrow Donor Program, and the National Heart, Lung and Blood Institute, the committee conducted an outcomes analysis to better understand these measures.
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From page 125... ...
Costs Associated with Increasing the Inventory As mentioned at the beginning of this chapter, the proposed National Cord Blood Stem Cell Bank Program will need to balance the competing interests of efficiency and equity. One effective way to evaluate efficiency is by analyzing the costs associated with the program.3 By modeling the life years gained against the cost per cord blood unit by taking into account such measures as overhead and discard rate, the break even reimbursement rate for a 50,000-unit inventory would be $15,336 per unit.
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From page 126... ...
RECOMMENDATIONS Recommendation 6.1: Forecasts of the required size of a national in ventory of cord blood should be based on the principles of efficiency and equity for identifiable groups of patients. The program should regularly examine data on · ways in which increases in cord blood inventory would benefit the length and the quality of life among potential transplant recipients; · the benefits and costs per unit for identifiable groups of patients; and · the effects of inventory policy on the financial viabilities of hemato poietic progenitor cell collection, storage, and distribution systems for hematopoietic progenitor cells.
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From page 127... ...
Recommendation 6.2: Continue to conduct outcomes research. The Health Resources and Services Administration and the National Insti tutes of Health should support further research directed toward under standing the relationships among inventory size, human leukocyte anti gen match quality, cell dose, multiple-unit transplants, and the benefits of hematopoietic progenitor cell transplantation to the length and qual ity of life.
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From page 128... ...
2005. A cost-benefit analysis of increasing cord blood inventory levels: An analysis prepared for the Commit tee on Establishing a National Cord Blood Stem Cell Bank, Institute of Medicine, Wash ington, DC.
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