Allogeneic stem cell transplantation. An economic comparison of bone marrow, peripheral blood, and cord blood technologies.
OBJECTIVE
To compare outcome attributes of three available technologies for stem cell transplantation--bone marrow transplantation (BM), peripheral blood cell transplantation (PB), and cord blood transplantation (CB). To compare the cost per recipient for the three technologies, incorporating all donor and antigen matching functions, as well as the transplantation procedures.


METHODS
Review of relevant literature using the CancerLit and HealthSTAR databases (plus earlier searches of MEDLINE and Embase) to summarize outcome differences. Estimations of cost per transplant using models drawing on Canadian experience.


RESULTS
The literature review indicated that PB may have a modest advantage over BM in terms of outcomes. The literature indicated that CB has longer engraftment times (although this may be due to inadequate controls). Our modeling exercise indicated that costs for PB and BM are similar. CB has a higher cost per recipient, due in large part to the higher testing costs for every donated unit.


CONCLUSIONS
Current literature is inadequate to provide an outcomes comparison of CB, PB, and BM. Viewed from a system-wide perspective, CB is a higher cost technique. However, PB and CB are emerging as technologies, and so our results should be viewed alongside the notion that there may be a steep learning curve in these technologies.
Jacobs
P
P
University of Alberta.
Hailey
D
D
Turner
R
R
MacLean
N
N
D016026:Bone Marrow Transplantation / Q000191:economics; D003362:Cost-Benefit Analysis; D005312:Fetal Blood; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics* / Q000379:methods*; D006801:Humans; D017063:Outcome Assessment, Health Care; D013673:Technology Assessment, Biomedical; D014184:Transplantation, Homologous