Access to Hematopoietic Cell Transplantation in the United States

Abstract

Hematopoietic cell-transplantation (HCT) is a highly specialized and resource-intense medical procedure that can be associated with disparities in access to transplantation. Barriers to access to HCT are multifactorial, complex and interrelated. Our current knowledge of specific barriers that prevent access to HCT is very limited. As the utilization of HCT increases, it is imperative that underserved populations receive the benefit of this life-saving procedure. We review the prevailing literature on access to HCT and describe research priorities for eliminating disparities in transplantation. Better understanding of these complex barriers will minimize inequities, inform health policy, guide development of interventions targeted to eliminate disparities and continue the expansion of HCT in the future.

Challenges to the Sustainability of the U.S. Public Cord Blood System

“…112,113 However, it is unclear whether this is due to more-generous coverage benefits among the privately insured, better access to care, or other factors.…”

Geographic access to hematopoietic cell transplantation services in the United States

“…13 Furthermore, patient sociodemographic characteristics such as age, gender and insurance status have also been shown to influence utilization of HCT services. 5 Additional barriers to accessing HCT include variation in physicians' referral patterns, 15 the availability of a suitable transplant donor for allogeneic HCT, 16 and securing payment for treatment via insurance coverage pre-approval or patient prepayment. 17 Our analysis did not include differences in hematologic disease incidence rates or HCT service needs among subpopulations.…”

“…As many of the HCT facilities are located in or near urban centers, residents living in rural regions must travel further than their urban counterparts to access these services. In addition to the geographic disparities in access, the complexity of interactions required among patient, provider and a health-care system in HCT likely create additional access barriers, 5 exacerbating disparities in geographic access to HCT services.…”

Quantitative and qualitative differences in use and trends of hematopoietic stem cell transplantation: a Global Observational Study

“…They point to the different requirements within high or low income countries, hence different cost-effectiveness considerations. 20,21,[26][27][28] Unrelated donor transplant rates were associated with GNI/capita, the presence of an unrelated donor registry and the number of registered donors. The association is likely reciprocal; high income countries perform more HSCT in general and are more likely to invest in an unrelated donor registry.…”

“…11,21,22,25 They were triggered in part by some rapid changes in the use of HSCT, such as for breast cancer or chronic myeloid leukemia 18,26 and by the rising awareness of the disturbing gap between unlimited requests and limited resources in any health care system. 27,28 Availability of resources, governmental support and access to therapy were identified as factors associated with use; availability of resources, evidence, external regulations and positive or negative expectations of transplant physicians as factors associated with diffusion. 11,25 These previous findings and the observations in this report form an objective basis for recommendations or guidelines by professional organizations.…”