Limiting access to allogeneic bone marrow transplantation in five Europeancountries: what can we learn about implicit rationing?

Background Allogeneic bone marrow transplantation is a complex procedure ex emplifying a class of new and emerging treatment modalities involving advan ced medical technologies with high costs. Objectives: To collect available data on volume of allogeneic bone marrow transplantation in five European c ountries for the period 1990-1994. To assess the opinion of selected physic ians on whether they felt that patients that would have benefited from a tr ansplant actually received a transplant in the same period. To assess their opinion on possible reasons for limited access. Method: Literature review and mailed self-administered questionnaire to the responsible physician at 76 transplant centres in Denmark, Germany, The Netherlands, Norway, and the UK. Results: Substantial geographical differences in transplantation rates between the five countries studied. For adult patients 62.5% of the respon dents felt that there was limited access to allogeneic bone marrow transpla ntation in the period. For children, the corresponding figure was 37.5%. Th e reasons for limited access cited most frequently were scarcity of facilit ies or transplant beds, scarcity of donors, and inadequate referral practic es. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.