Allogeneic stem cell transplantation - An economic comparison of bone marrow, peripheral blood, and cord blood technologies

Objectives: To compare outcome attributes of three available technologies f or stem cell transplantation-bone marrow transplantation (BM), peripheral b lood cell transplantation (PB), and cord blood transplantation (CB). To com pare the cost per recipient for the three technologies, incorporating all d onor and antigen matching functions, as well as the transplantation procedu res. Methods: Review of relevant literature using the CancerLit and HealthSTAR d atabases (plus earlier searches of MEDLINE and Embase) to summarize outcome differences. Estimations of cost per transplant using models drawing on Ca nadian experience. Results: The literature review indicated that PB may have a modest advantag e over BM in terms of outcomes. The literature indicated that CB has longer engraftment times (although this may be due to inadequate controls). Our m odeling exercise indicated that costs for PB and BM are similar. CB has a h igher 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 compar ison of CB, PB, and BM. Viewed from a system-wide perspective, CB is a high er 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.