Expenses as an Issue Inhibiting the Use of Cord Blood

Transplantation

Michael Boo, Chief Strategy Officer National Marrow Donor Program June 8, 2013

Overview

• The cost of cord transplantation impacts the use of cord blood units – Insurance coverage – Time commitment

• Elements of Cost – The product – The procedure

• What’s next

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5573 Transplants in 2011

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4

0

200

400

600

800

1,000

1,200

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Pediatric Recipients (Age Younger than 18 Years)

Bone Marrow Peripheral Blood Stem Cells Cord Blood

NMDP Transplants by Cell Source

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-100 200 300 400 500 600 700 800 900

1,000

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Bone Marrow Peripheral Blood Stem Cells Cord Blood

*Minority includes those patients with race of CAU, DEC, OTH, UNK and Hispanic ethnicity.

NMDP Transplants for Minority Patients by Cell Source

Historical Cord Transplants

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2012 was the first year that we saw a drop in cord transplants for adult patients (58% of total). In 2011, 60% of all cord transplants were for adult patients, compared to only 46% in 2007.

Historical Cord Transplants

37% of all cord transplants in 2012 were multi-cord compared to 41% in 2011

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Product Related Costs

• Cost of Collection – Staff vs. OB model – The goal of diversity

• Cost of Banking – TNC cut off decision – Testing services – The costs of process

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Median TNC of Cord Shipments

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Cord Shipments by TNC Group

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Caucasian vs. Minority – 2012 Inventory

36% of Caucasian inventory has TNC higher than 124 compared to 32% of Minority inventory

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Caucasian vs. Minority – 2012 Recruitment

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62% of Caucasian recruitment has TNC higher than 124 compared to 37% of Minority recruitment

Caucasian vs. Minority – 2012 Shipments

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90% of Caucasian shipments have TNC higher than 124 compared to 83% of Minority shipments

Caucasian vs. Minority – 2012 Shipments, cont. – Patient Age 0-17

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30% of shipments to minority pediatrics had a TNC less than 125

Caucasian vs. Minority – 2012 Shipments, cont. – Patient Age 18+

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Less than 5% of shipments to adult recipients had a TNC less than 125

Product Related Costs

• Cost of Regulation – Capital costs – Higher staffing costs

• Other Factors – Research interest of the institution – Overhead associated with the sponsoring institution – Lack of scale

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Procedure Related Costs

• Patient Management Challenges – Slower engraftment – Higher incidence of relapse – Greater incidence of infectious diseases and

other pre-engraftment complications – Management of the product requires

specialized knowledge

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Procedure Related Costs

• Cost challenges – Slower engraftment requires longer inpatient

stay – Greater incidence of complications requires

more blood products, drugs and other medical services

– Need for second unit for adults doubles cost of the graft source

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What Needs to be Done?

• Education and Awareness – Promote cord blood studies as they get

published – Provide clinical sample protocols and SOPs to

centers considering cord blood transplant – Develop best practice guidelines for clinical

management

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What Needs to be Done?

• Address the issue of slow engraftment • Better inventory selection

• Identification of other selection criteria

• Pursue expansion or other technologies

• Continue to investigate use of cord blood in other diseases

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What Needs to be Done - Banking

• Assist Cord Blood Banks to become more efficient and effective – Provide guidance on economics of banking

• Update NMDP 2010 market analysis • Study impact of FDA compliance

– Identify and promote best practices in banking operations • Ongoing effort through Cord Blood Advisory

Group

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