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Availability and appropriateness of allogeneic bone marrow transplantation for chronic myeloid leukemia in 10
G Silberman1, M G Crosse, E A Peterson
1Program Evaluation and Methodology Division, General Accounting Office, Washington, DC 20548.
Insights
Allogeneic bone marrow transplantation (BMT) for chronic myeloid leukemia (CML) varies significantly across developed nations. The United States does not lead in BMT access or appropriateness for CML patients.
Area of Science:
- Hematology
- Oncology
- Health Services Research
Background:
- Allogeneic bone marrow transplantation (BMT) is the sole curative treatment for chronic myeloid leukemia (CML).
- Healthcare systems and economic factors influence access to this complex procedure.
- International comparison of BMT availability and appropriateness for CML is crucial.
Purpose of the Study:
- To assess the availability and appropriateness of allogeneic BMT for CML in 10 economically advanced countries.
- To compare transplantation rates, time from diagnosis to transplant, and disease stage at transplant.
- To evaluate the United States' position relative to other developed nations in CML BMT provision.
Main Methods:
- Data collected from 9873 allogeneic BMTs across 208 centers in 10 countries (1989-1991).
- Information gathered via transplantation registries and mailed surveys.
- Disease incidence data sourced from national and regional cancer registries.
Main Results:
- Transplantation rates for CML varied twofold across countries (0.26-0.54 per 100,000 annually).
- Median time from diagnosis to transplant ranged from 6.8 to 15.4 months.
- A significant proportion of patients (up to one-third) received transplants in advanced disease phases (accelerated or blast).
Conclusions:
- The United States' access to high-technology treatments like BMT for CML is not exceptional compared to other developed nations.
- No measure of BMT availability or appropriateness for CML in the US surpassed the nine other countries studied.
- Findings challenge assumptions about universal access to advanced medical care in the US.
Background:
Allogeneic bone marrow transplantation, a sophisticated and expensive procedure, is the only curative therapy for chronic myeloid leukemia (CML). We examined the availability and appropriateness of allogeneic bone marrow transplantation for CML in 10 economically advanced countries with diverse health care systems. For each country we obtained data on the likelihood of transplantation to treat CML in patients under the age of 55 years, the length of time from diagnosis to transplantation, and the stage of disease at the time of transplantation.
Methods:
Data were collected on 9873 allogeneic bone marrow transplantations performed at 208 centers in 10 countries from 1989 through 1991. Data were acquired from transplantation registries and by means of a mailed survey of all centers and teams that did not contribute data to registries. Data on the incidence of disease were drawn from national and regional cancer registries.
Results:
Among the 10 countries there was a twofold difference between the lowest and highest rates of transplantation to treat CML (0.26 to 0.54 per 100,000 population per year); Swedish patients were the most likely to receive a transplant, and German patients the least likely. The median length of time from diagnosis to transplantation ranged from 6.8 to 15.4 months. In all countries, most transplantations were performed in the chronic phase of the disease, but as many as a third of patients received transplants in the less favorable accelerated or blast phase. The values for the United States fell near the middle of those for the 10 countries on all measures.
Conclusions:
Our findings challenge the assumption that the United States is unique in providing broad access to high-technology treatments. On no measure of the availability or appropriateness of transplantation for CML did it surpass the other nine countries studied.