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Demand Has Stagnated, Costs and Competition Have Increased

• The national program has significantly increased the publicly available inventory, but the proportion of HSC transplants using cord blood has been declining from about 12 percent of all HSC transplants to about 8 percent from 2010 to 2015.
• Obtaining higher–TNC count units increases costs because CBBs have to collect more units to get a useable or bankable unit. Banks lose money on the collection of low–TNC count units, however, as they are very unlikely to be used.
• Domestic and international CBBs are competing, and the number of U.S. CBBs and their inventories continue to grow. If the number of CBBs and CBUs rises while demand remains stagnant or falls, CBBs will face financial pressure.

Relative Clinical Effectiveness Remains Unclear

• Some interviewees said that CBUs are used only as a last resort, whereas others mentioned a preference for CBUs, particularly for certain types of patients. Thus, any comparison of patients using different HSC sources suffers from a significant selection bias.
• The majority of the literature follows patients for only a short time period. Because cord blood transplants take longer to engraft, such a truncation will bias results toward more-favorable outcomes for other sources.
• Higher–TNC count CBUs have been shown to offset some amount of genetic mismatching, which is important for minorities.

Cord Blood Transplantation Is Not a Panacea Treatment, But Has Significant Societal Value

• We estimated the annual societal benefit of having a national inventory to be around $1.7 billion relative to an annual cost of maintaining the inventory at about $60–70 million.
• CBUs are not the answer for every patient, but their availability is crucial for hundreds of patients every year who have no alternative, especially for pediatric and minority patients.
• Access for minorities can be increased by incentivizing banks to collect more minority units or to collect larger CBUs from all donors.