Geographic access to hematopoietic stem cell transplantation (HSCT).

Abstract

e16517 Background: Hematopoietic Stem cell transplantation (HSCT) has been used with considerable success in the management of patients with otherwise incurable malignant and nonmalignant conditions. Transplantation is a resource-intensive endeavor that requires specialized personnel and equipment available through a limited number of institutions. Transplant patients tend to undergo prolonged hospitalizations and require frequent follow up visits. The optimal geographic distribution of transplant centers has not been determined, in fact the current distribution of centers relative to geographic area and population is unknown. Methods: Using the 2008 county level census estimate data, the proportion of the population living within a combined statistical area (CSA) with a transplant center or within an hour-travel of one was determined. Combined Statistical Areas, as defined by the Office of Budget and Management (OMB), comprise two or more adjacent Metropolitan or Micropolitan Statistical Areas that have moderate social and economic ties as measured by commuting. Travel time was determined by the shortest driving time between county centroids and the closest HSCT center, regardless of state lines. The list of adult HSCT centers was obtained from the National Marrow Donor Program (NMDP). Results: In 2009, there were 102 adult HSCT centers listed by the NMDP in the United States. An estimated 60.92% of the US population have easy access to a HSCT center as defined above. Regional access was as follows: Northeast, 78.26%; West, 64.16%; Midwest, 57.03%; and South, 52.65%. Nine states have no centers, while 10% of centers are located in just 2 counties; Philadelphia, Pa and Cook, Il. Conclusions: 60.92% of the U.S. population have easy geographic access to a HSCT center, however, there is both state and regional variation in access to these centers. The greatest proportion of the population with access was highest in the Northeast and lowest in the South. There is need for further research to determine the impact of geographic access in rates of transplantation, outcomes and the economic and social impact of lack geographic of access. No significant financial relationships to disclose.