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."