Cost-Effectiveness of Private Umbilical Cord Blood Banking

Abstract

Bone marrow transplant is the preferred method of treatment in almost all clinical situations, but survival rates using umbilical cord blood stem cell transplant could theoretically be equivalent. A large number of private companies in the United States now market storage of umbilical cord blood directly to consumers, contending that banking such blood for future transplant provides a "biologic insurance" for unborn children. The results of 2 recent surveys clearly demonstrate the rare use of privately banked cord blood. The first reported that only about 100 of the approximately 460,000 privately banked cord blood units had been shipped for transplantation. The second reported that privately banked cord blood was used in the United States and Canada for only 9 autologous and 41 allogenic transplants. Because of the rare need, professional medical organizations have recommended against the use of private umbilical cord blood banking unless there is a clear requirement based on a known disease in a family member. This study was designed to investigate the cost-effectiveness of private umbilical cord blood banking. Using a decision-analytic model, a number of baseline assumptions were made: (1) Cord blood was presumed to be collected and stored for 20 years at a cost of $3620, (2) There was a 0.04% chance of requiring an autologous stem cell transplant and a 0.07% chance of a sibling requiring an allogenic stem cell transplant, and (3) a 50% reduced risk of graft-versus-host disease for a sibling using banked umbilical cord blood. Base case analysis showed that private cord blood banking was not cost-effective in comparison with no cord blood banking because it cost an additional $1,374,246 per life-year gained. The gain in life years obtained by use of private umbilical cord blood banking was 0.0026 life years (29.9848 years at a cost of $3620 for private banking compared with 29.9822 years at a cost of $0 for no private cord blood banking). Private cord blood banking became cost-effective in a one-way sensitivity analysis only when the likelihood of a child requiring an autologous stem cell transplant exceeded 1 in 110, the likelihood of a sibling requiring an allogenic stem cell transplant rose to 1 in 43, or the cost of umbilical cord blood banking was reduced to $262 (about 7% of baseline). Many parents appear to overestimate the likelihood of the need for privately banked umbilical cord blood. Those considering this intervention should be informed of the remote possibility that cord blood will be used for a child in their family.