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Use of Cost-Effectiveness Analysis to Determine Inventory Size for a National Cord Blood Bank

Department of Health Policy and Management, Rollins School of Public Health, Atlanta, Georgia, david.howard{at}emory.edu

David Meltzer, MD, PhD

Department of Medicine, Department of Economics, Graduate School of Public Policy Studies, University of Chicago, Chicago, Illinois

Craig Kollman, PhD

Jaeb Center for Health Research, Tampa, Florida

Martin Maiers, BS

National Marrow Donor Program, Minneapolis, Minnesota

Brent Logan, PhD

Division of Biostatistics, Medical College of Wisconsin, Milwaukee

Loren Gragert, BS, BA

National Marrow Donor Program, Minneapolis, Minnesota

Michelle Setterholm, BS

National Marrow Donor Program, Minneapolis, Minnesota

Mary M. Horowitz, MD

International Bone Marrow Transplant Registry, Health Policy Institute, Medical College of Wisconsin, Milwaukee

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.

Key Words: cost-benefit analysis • fetal blood • umbilical cord blood • bone marrow transplantation • hematopoietic stem cell transplantation.

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