title: Banking or Bankrupting: Strategies for Sustaining the Economic Future of Public Cord Blood Banks.
abstract: BACKGROUND
  Cord blood is an important source of stem cells. However, nearly 90% of public cord blood banks have declared that they are struggling to maintain their financial sustainability and avoid bankruptcy. The objective of this study is to evaluate how characteristics of cord blood units influence their utilization, then use this information to model the economic viability and therapeutic value of different banking strategies.
  
  
  METHODS
  Retrospective analysis of cord blood data registered between January 1st, 2009 and December 31st, 2011 in Bone Marrow Donor Worldwide. Data were collected from four public banks in France, Germany and the USA. Samples were eligible for inclusion in the analysis if data on cord blood and maternal HLA typing and biological characteristics after processing were available (total nucleated and CD34+ cell counts). 9,396 banked cord blood units were analyzed, of which 5,815 were Caucasian in origin. A multivariate logistic regression model assessed the influence of three parameters on the CBU utilization rate: ethnic background, total nucleated and CD34+ cell counts. From this model, we elaborated a Utilization Score reflecting the probability of transplantation for each cord blood unit. We stratified three Utilization Score thresholds representing four different banking strategies, from the least selective (scenario A) to the most selective (scenario D). We measured the cost-effectiveness ratio for each strategy by comparing performance in terms of number of transplanted cord blood units and level of financial deficit.
  
  
  RESULTS
  When comparing inputs and outputs over three years, Scenario A represented the most extreme case as it delivered the highest therapeutic value for patients (284 CBUs transplanted) along with the highest financial deficit (USD 5.89 million). We found that scenario C resulted in 219 CBUs transplanted with a limited deficit (USD 0.98 million) that charities and public health could realistically finance over the long term. We also found that using a pre-freezing level of 18 x 10(8) TNC would be the most cost-effective strategy for a public bank.
  
  
  CONCLUSIONS
  Our study shows that a swift transition from strategy A to C can play a vital role in preventing public cord blood banks worldwide from collapsing.
authors.affiliation: ESSEC Business School, Paris-Singapore, France.|Assistance Publique Hôpitaux de Marseille CIC BT 1409, Marseille, France.|Vascular Research Center of Marseille, Aix Marseille University, Marseille, France.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Magalon
authors.affiliation: National Marrow Donor Program, Minneapolis, Minnesota, United States of America.
authors.forename: Martin
authors.initials: M
authors.lastname: Maiers
authors.affiliation: Carolinas Cord Blood Bank, Duke University, Durham, North Carolina, United States of America.
authors.forename: Joanne
authors.initials: J
authors.lastname: Kurtzberg
authors.affiliation: NHS Cord Blood Bank, NHS Blood and Transplant, London, United Kingdom.
authors.forename: Cristina
authors.initials: C
authors.lastname: Navarrete
authors.affiliation: National Cord Blood Program, New York Blood Center, New York, New York, United States of America.
authors.forename: Pablo
authors.initials: P
authors.lastname: Rubinstein
authors.affiliation: NHS Cord Blood Bank, NHS Blood and Transplant, London, United Kingdom.
authors.forename: Colin
authors.initials: C
authors.lastname: Brown
authors.affiliation: INSERM U1138, Paris Descartes University, UPMC, Paris, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Schramm
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Jérome
authors.initials: J
authors.lastname: Larghero
authors.affiliation: INSERM U1138, Paris Descartes University, UPMC, Paris, France.|Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Katsahian
authors.affiliation: Institut Paoli-Calmettes, CIC BT 1409, Marseille, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Chabannon
authors.affiliation: EFS Alpes Méditerranée, Marseille, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Picard
authors.affiliation: DKMS Cord Blood Bank, Dresden, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Platz
authors.affiliation: DKMS Cord Blood Bank, Dresden, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Schmidt
authors.affiliation: ESSEC Business School, Paris-Singapore, France.
authors.forename: Gregory
authors.initials: G
authors.lastname: Katz
mesh_terms: D001771:Blood Banks / Q000191:economics* / Q000706:statistics & numerical data*; D002452:Cell Count; D005006:Ethnicity; D005312:Fetal Blood / Q000166:cytology*; D006801:Humans