According to the Worldwide Network of Blood and Marrow Transplantation, approximately
hematopoietic stem cell transplantations (HCSTs) are performed every year. The costs associated with transplantation can be overwhelming for most families. The
of undergoing a HCST in the United States can range from $36,000 to $88,000 for a single autologous (using one’s own cells) transplantation to $200 000 or more for a myeloablative procedure involving an unrelated donor.
Graft sources for HCST include bone marrow (BM), peripheral blood (PB) and umbilical cord blood (UCB). The stem cells derived from these sources are used in a growing number of HCSTs to treat many malignant and non-malignant conditions. The accessibility, affordability, post-transplant care, quality of match and likelihood of grafting for each source is carefully considered to determine the best transplant outcome for an individual patient. Given rising healthcare costs, it’s important for families to consider the financial impact of a transplant procedure. So, how does cord blood compare to other transplant sources in terms of cost?
Some encouraging news came from a recent study shared by Dr. Shernan Holton of the University of Minnesota Medical Center, which showed lower long-term healthcare costs associated with umbilical cord blood transplants than bone marrow and peripheral blood. Before we delve into the study results, let’s review some of cord blood's immunological and cost advantages as a graft source.
Why is Umbilical Cord Blood Beneficial?
Studies have shown that the proportion of highly proliferative hematopoietic stem cells is greater in UCB as compared to BM or PB allografts. To date, over 40,000 UCB transplants have been performed worldwide to treat nearly 80 conditions; many of these conditions include certain types of lymphoma and leukemia.
Statistics given by The American Cancer Society estimate 1,898,160 new cancer cases will be diagnosed in the U.S. this year. According to online research from the National Cancer Institute published by Mariotto et al., “the national cancer-attributable cost for medical services and prescription drugs is expected to increase from $183 billion in 2015 to $246 billion by 2030—an increase of 34% due to population changes alone.” The financial burden of diagnosis coupled with pre and post-transplant care can significantly impact a family’s decision to go with a recommended care plan. According to an article published in the American Cancer Society Journal, a patient’s compliance to recommended treatment management based upon the financial strain of rising premiums, deductibles, and copayments can undermine treatment success.
Ideally, a successful transplant equates to fewer follow-up hospital admissions. In turn, less post-transplant care visits and services mean less money spent. There are many benefits to using umbilical cord blood in transplantation. Specifically, UCB transplants are associated with a lower likelihood of graft-versus-host disease and a greater capacity for homing and hematopoietic reconstitution than other HCST sources. Equally beneficial is the cost advantage of UCB in transplantation.
What Does the Study Reveal About UCB Post-Transplant Costs?
Results of Minnesota University Medical Center’s composite analysis looked at variables such as services, procedures (including labs and imaging), medications prescribed, and relative value units billed to patients for professional services to estimate the healthcare burden among BM, PB and UCB transplant patients. The study included 1077 allogeneic HSCT recipients at the University of Minnesota Medical Center transplanted between 2000-2016, ages 18+. Patients were followed in three phases of HSCT recovery: Day 0-100 (early), Day 101-365 (intermediate), and Years 1-5 (late). The above factors were combined to tally a composite healthcare burden score, with the lowest (best) composite score attributed to UCB in both the intermediate and long-term recovery phases.
Study outcomes were observed for each of the following areas:
Within the first 100 days post-transplant, patients were seen for a median of 62 days (several times per week). In the intermediate recovery time period, fewer visits were required but remained the lowest among patients with UCB; this also continued in years 1-5.
UCB recipients had the lowest number of procedures in the intermediate and late stages, while bone marrow patients needed the greatest number of procedures.
UCB patients had the lowest median lab counts after one year.
Patients with PBSC had the least amount of medication prescribed in the initial days (0-100) recorded at 132 compared to BM, which had the highest amount of medication prescribed at 232. UCB was somewhere in between at 203.
However, compared to days 101-365, UCB patients experienced a significant decrease in the number of medications prescribed. Furthermore, in years 1-5, UCB retained the lowest medication count compared to PBSC.
This trend plays out again when looking at RVU counts (relative value units billed to patients for professional services), with PBSC being the lowest in the initial stage days 0-100, but significantly less in UCB patients in days 1010-365 and subsequently in years 1-5, at respectively, 174.4 and 30.3.
What are Some Considerations for This Study?
All of the above factors were added together to determine a composite healthcare burden score. Overall, the best scores were assigned to umbilical cord blood recipients for both the intermediate and late stages of recovery.
The above data also translates to the length of hospital stays and the number of hospital admissions over time. Important demographics suggest that 40.8% of study participants were treated for Acute Myeloid Leukemia. 88% of PBSC transplants came from a sibling, 57% of BM transplants came from a matched, unrelated donor and 85% of UCB transplant participants received a double cord blood transplantation. The cord blood used for double transplantation consisted of varying matched degree units, not specified during the analysis.
Dr. Holton expressed the need for funding of a more extensive, nationalized study. She also expressed her hope for the healthcare community and patients to consider the long-term outcomes when looking at different graft sources. Learn more about this study.
What are the Cost Implications of Storing Cord Blood Privately?
Cord blood can have a more significant cost advantage when stored in a private/family cord blood bank. For example, families who store with Cryo-Cell have multiple opportunities to retrieve their cord blood specimen, which is often needed in double transplantation. According to one source, the cost of acquiring two cord blood grafts in the public registry can be upwards of $80,000. Additionally, our five- chambered storage bag opens the door for future advancements in the ex vivo (outside the body) expansion of stem cells. This allows families to use a portion of their stem cells for clinical application and still retain more stem cells for future indications.
Storing privately also means that the family has full rights and immediate access to treat nearly 80 diseases, whereas a family that donates gives up their exclusive rights and access. The cost to retrieve their specimen in the national registry, if it’s still available, costs approximately $40,000. Retrieval of a specimen in a private bank is free. The cost of preservation with a family bank varies but consists of a minimal, annual storage fee that is significantly less than the cost of procuring a specimen in the public registry.
Additionally, families who store with us can benefit from regularly offered specials and discounts as well as our Flex Payment Program and other finance plans. In the event a stored cord blood unit processed using our PrepaCyte-CB method fails to engraft in transplantation, we offer a $100,000 engraftment guarantee. Cryo-Cell maintains a 100% viability rate among all of our transplants, a number not reported by any other family cord blood bank. These extra benefits ensure that every family who stores with us receives the best preservation services in the industry and the best chance of transplant success at affordable costs.
There are numerous other benefits to preserving your baby’s umbilical cord-derived stem cells. Learn more about their importance and the cost of preservation, including our current finance plans and promotion, by visiting our website!