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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.

Hematopoietic stem cells (HSCs) — from bone marrow, peripheral blood, or umbilical cord blood — are used to treat patients with cancers such as leukemia or lymphoma, disorders of the blood and immune systems, severe aplastic anemia, sickle cell disease, and certain inherited metabolic diseases. In addition to cord blood's direct therapeutic value to patients, it is also used for basic research on blood, blood stem cells, and immune cells.

In recent years, the U.S. government (through the Health Resources and Services Administration) has endeavored to increase the overall national inventory — which currently contains over 200,000 units — as well as the number of high-quality units and the number of units from racial/ethnic minorities. Despite the important clinical and research roles of cord blood products and a clear public health need for increasing and diversifying our national inventory, little is systematically known about the economics of the industry, including what banks' costs and revenues are, cost structures and determinants of financial health, successful collection efforts for cord blood banks (CBBs), whether the market is competitive or similar to a public goods market, and the role of the government in the market.

In this report, we aim to fill these knowledge gaps by (1) describing the existing public CBB system, (2) assessing current trends and economic relationships from the perspective of key stakeholders in the public CBB system, and (3) providing recommendations to improve the economic sustainability of the public CBB system.

• Chapter One

  Introduction

• Chapter Two

  Overview of the U.S. Cord Blood System

• Chapter Three

  Methods

• Chapter Four

  Trends Affecting Public Cord Blood System Sustainability

• Chapter Five

  Trends in Public Cord Blood Banking and Shipping

• Chapter Six

  Economics of Cord Blood

• Chapter Seven

  Cord Blood Bank Financial Sustainability

• Chapter Eight

  Factors Shaping the Public Cord Blood Sector's Future

• Chapter Nine

  Government Intervention in the Public Cord Blood System

• Chapter Ten

  Themes, Recommendations, and Conclusion

• Appendix A

  Interview Protocols

• Appendix B

  Economic Modeling

• Appendix C

  Donor Race/Ethnicity Matches