SAN DIEGO--For hospitals that haven't already established a hematopoietic
stem cell program, Bruce E. Hillner, MD, advises them not to do
so. "If you don't have a program now, buy the services elsewhere.
That is a much smarter way to go," said Dr. Hillner, associate
professor of medicine, Medical College of Virginia, Richmond.
Dr. Hillner, whose research in the 1990s has focused on the cost
effectiveness of various cancer treatments and patterns of cancer
care, spoke at the Eighth Annual Cancer Care Symposium, sponsored
by the Society for Ambulatory Care Professionals and Health Technology
Assessment of the American Hospital Association.
"I suggest that your centers not put capital into the bricks
and mortar of a stem cell center. You should focus instead on
the framework of agreements and patient protocols," he advised.
"Focus on access to services versus delivering these services."
He recommends that institutions negotiate for stem cell services
with programs that are already well entrenched, using access to
national oncology trials as a quality indicator.
Dr. Hillner further suggested that there is no need for any new
allogeneic centers in North America and "infrequent windows
of opportunity" for new autologous transplant centers. A
new autotrans-plant center would only be feasible in an area where
there is little managed care, little contracting or dialogue between
medical centers, and an underutilized blood bank, he said.
Dr. Hillner noted that health insurers are less likely now to
raise their eyebrows toward high-dose chemotherapy/transplantation
and today rarely invoke "experimental" exclusion when
reviewing a case.
Nonetheless, he said, "I would guess that 20% to 40% of transplants
to support high-dose therapy are being done on incredibly shaky
ground." He has seen cases where the chances for benefiting
from transplant were "infinitesimal at best."