1. Expenses as an Issue Inhibiting
the Use of Cord Blood
Transplantation
Michael Boo, Chief Strategy Officer
National Marrow Donor Program
June 8, 2013

2. Overview
• The cost of cord transplantation impacts the use
of cord blood units
– Insurance coverage
– Time commitment
• Elements of Cost
– The product
– The procedure
• What’s next
2

3. 5573 Transplants in 2011
3

4. 4
0
200
400
600
800
1,000
1,200
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
PediatricRecipients(Age Youngerthan18 Years)
Bone Marrow Peripheral Blood Stem Cells Cord Blood
NMDP Transplants by Cell Source

5. 5
-
100
200
300
400
500
600
700
800
900
1,000
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Bone Marrow Peripheral Blood Stem Cells Cord Blood
*Minority includes those patients with race of CAU, DEC, OTH, UNK and Hispanic ethnicity.
NMDP Transplants for Minority
Patients by Cell Source

6. Historical Cord Transplants
6
2012 was the first year that we saw a drop in cord transplants for adult patients (58% of
total). In 2011, 60% of all cord transplants were for adult patients, compared to only 46% in
2007.

7. Historical Cord Transplants
37% of all cord transplants in 2012 were multi-cord compared to 41% in 2011
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8. Product Related Costs
• Cost of Collection
– Staff vs. OB model
– The goal of diversity
• Cost of Banking
– TNC cut off decision
– Testing services
– The costs of process
8

9. Median TNC of Cord Shipments
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10. Cord Shipments by TNC Group
10

11. Caucasian vs. Minority – 2012 Inventory
36% of Caucasian inventory has TNC higher than 124 compared to 32% of Minority inventory
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12. Caucasian vs. Minority – 2012 Recruitment
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62% of Caucasian recruitment has TNC higher than 124 compared to 37% of Minority recruitment

13. Caucasian vs. Minority – 2012 Shipments
13
90% of Caucasian shipments have TNC higher than 124 compared to 83% of Minority shipments

14. Caucasian vs. Minority – 2012 Shipments,
cont. – Patient Age 0-17
14
30% of shipments to minority pediatrics had a TNC less than 125

15. Caucasian vs. Minority – 2012 Shipments,
cont. – Patient Age 18+
15
Less than 5% of shipments to adult recipients had a TNC less than 125

16. Product Related Costs
• Cost of Regulation
– Capital costs
– Higher staffing costs
• Other Factors
– Research interest of the institution
– Overhead associated with the sponsoring institution
– Lack of scale
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17. Procedure Related Costs
• Patient Management Challenges
– Slower engraftment
– Higher incidence of relapse
– Greater incidence of infectious diseases and
other pre-engraftment complications
– Management of the product requires
specialized knowledge
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18. Procedure Related Costs
• Cost challenges
– Slower engraftment requires longer inpatient
stay
– Greater incidence of complications requires
more blood products, drugs and other medical
services
– Need for second unit for adults doubles cost
of the graft source
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19. What Needs to be Done?
• Education and Awareness
– Promote cord blood studies as they get
published
– Provide clinical sample protocols and SOPs to
centers considering cord blood transplant
– Develop best practice guidelines for clinical
management
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20. What Needs to be Done?
• Address the issue of slow engraftment
• Better inventory selection
• Identification of other selection criteria
• Pursue expansion or other technologies
• Continue to investigate use of cord blood in
other diseases
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21. What Needs to be Done - Banking
• Assist Cord Blood Banks to become more
efficient and effective
– Provide guidance on economics of banking
• Update NMDP 2010 market analysis
• Study impact of FDA compliance
– Identify and promote best practices in banking
operations
• Ongoing effort through Cord Blood Advisory
Group
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