Expenses as an Issue Inhibiting the Use of Cord Blood Transplantation
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Transcript of Expenses as an Issue Inhibiting the Use of Cord Blood Transplantation
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Expenses as an Issue Inhibiting the Use of Cord Blood
Transplantation
Michael Boo, Chief Strategy Officer National Marrow Donor Program June 8, 2013
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Overview
• The cost of cord transplantation impacts the use of cord blood units – Insurance coverage – Time commitment
• Elements of Cost – The product – The procedure
• What’s next
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5573 Transplants in 2011
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Pediatric Recipients (Age Younger than 18 Years)
Bone Marrow Peripheral Blood Stem Cells Cord Blood
NMDP Transplants by Cell Source
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Bone Marrow Peripheral Blood Stem Cells Cord Blood
*Minority includes those patients with race of CAU, DEC, OTH, UNK and Hispanic ethnicity.
NMDP Transplants for Minority Patients by Cell Source
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Historical Cord Transplants
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2012 was the first year that we saw a drop in cord transplants for adult patients (58% of total). In 2011, 60% of all cord transplants were for adult patients, compared to only 46% in 2007.
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Historical Cord Transplants
37% of all cord transplants in 2012 were multi-cord compared to 41% in 2011
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Product Related Costs
• Cost of Collection – Staff vs. OB model – The goal of diversity
• Cost of Banking – TNC cut off decision – Testing services – The costs of process
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Median TNC of Cord Shipments
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Cord Shipments by TNC Group
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Caucasian vs. Minority – 2012 Inventory
36% of Caucasian inventory has TNC higher than 124 compared to 32% of Minority inventory
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Caucasian vs. Minority – 2012 Recruitment
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62% of Caucasian recruitment has TNC higher than 124 compared to 37% of Minority recruitment
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Caucasian vs. Minority – 2012 Shipments
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90% of Caucasian shipments have TNC higher than 124 compared to 83% of Minority shipments
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Caucasian vs. Minority – 2012 Shipments, cont. – Patient Age 0-17
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30% of shipments to minority pediatrics had a TNC less than 125
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Caucasian vs. Minority – 2012 Shipments, cont. – Patient Age 18+
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Less than 5% of shipments to adult recipients had a TNC less than 125
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Product Related Costs
• Cost of Regulation – Capital costs – Higher staffing costs
• Other Factors – Research interest of the institution – Overhead associated with the sponsoring institution – Lack of scale
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Procedure Related Costs
• Patient Management Challenges – Slower engraftment – Higher incidence of relapse – Greater incidence of infectious diseases and
other pre-engraftment complications – Management of the product requires
specialized knowledge
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Procedure Related Costs
• Cost challenges – Slower engraftment requires longer inpatient
stay – Greater incidence of complications requires
more blood products, drugs and other medical services
– Need for second unit for adults doubles cost of the graft source
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What Needs to be Done?
• Education and Awareness – Promote cord blood studies as they get
published – Provide clinical sample protocols and SOPs to
centers considering cord blood transplant – Develop best practice guidelines for clinical
management
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What Needs to be Done?
• Address the issue of slow engraftment • Better inventory selection
• Identification of other selection criteria
• Pursue expansion or other technologies
• Continue to investigate use of cord blood in other diseases
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What Needs to be Done - Banking
• Assist Cord Blood Banks to become more efficient and effective – Provide guidance on economics of banking
• Update NMDP 2010 market analysis • Study impact of FDA compliance
– Identify and promote best practices in banking operations • Ongoing effort through Cord Blood Advisory
Group
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