Breast Cancer and Autologous BoneMarrow Transplantationin the United States
Prof Cindy Farquhar MD MPH
University of Auckland, NZ
Breast Cancer and Autologous BoneMarrow Transplant (ABMT)
180,000 US women are diagnosed withbreast cancer each year
46000 US women die annually
60% of women with metastatic disease diewithin 10 years of diagnosis
Questions
How many US women with breastcancer had autologous bone marrowtransplantation ?
What was the mortality associatedwith the procedure ?
What was the cost of the procedure ?
Methods 1: Health CareUtilization Project Database
National Inpatient Statistics ofHCUP: discharge statistics from 22states, weighted to give nationalestimates, commenced 1993
Identified women with breast cancerusing ICD-9 codes
Identified women with breast cancerand ABMT using ICD-9 codes
Methods 2: American BoneMarrow Transplantation Registry
Voluntary registration of cases fromclinics
Estimate that the register onlycollects data from 50-60% of cases
Commenced 1989
HCUP data for number of women withbreast cancer who had HDC & ABMT
1993
1994
1995
1996
1997
1998
1999
2000
2001
No.withBreastCa*
519
510
529
520
548
571
568
580
618
No.withHDC+ABMT
4225
3863
5243
5629
6424
4850
4510
2431
3163
BCandHDC+ABMT
2132
2432
3073
3312
3030
2769
2033
461
563
* x 1,000Total=19795
HCUP: In Hospital Mortality
1993
1994
1995
1996
1997
1998
1999
2000
2001
Inpatientmortality(%)
3.7
3.6
2.0
2.9
1.9
1.8
1.3
1.2
3.5
No. ofdeaths
78
85
60
96
73
48
25
5
20
Medianage
44
45
45
45
47
47
47
45
46
HCUP : Length of Stay & Charges
1993
1994
1995
1996
1997
1998
1999
2000
2001
Medianlength ofstay
24
23
20
20
20
20
19
20
21
MedianCharges($) *
103,924
103,540
87,062
85,305
82,881
78,468
71,760
90,029
107,412
* Hospital charges only
HDC/ABMT 1993-2001 for Breast Cancer
Number of womenwith breast cancer andHDC/ABMT fromregistry data
Year
Numbers
1989
272
1990
332
1991
743
1992
1212
1993
1459
1994
1963
1995
2466
1996
2978
1997
333
1998
3478
1999
1876
2000
567
2001
231
Total
18140
Figures estimated to beonly 50-60% - total likelyto be 30,000 – 40,000
High Dose Chemotherapy and AutologousBone Marrow or Stem Cell Transplant:
Summary:
1989-2001 approximately 30,000 – 40,000women received an unproven, life-threatening and expensive treatment
It is estimated that at least 600 women diedfrom the treatment
Hospital costs over 10 years are likely to beupwards of $2 billion
Acknowledgements
Agency for Healthcare Research andQuality
Claudia Steiner
Robert Wood Johnson Foundation
RAND
The Commonwealth Fund