Availability and appropriateness of allogeneic bone marrow transplantation for chronic myeloid leukemia in 10 countries. N Engl J Med 1994 Oct 20;331(16):1063-7
Date
10/20/1994Pubmed ID
8090167DOI
10.1056/NEJM199410203311606Scopus ID
2-s2.0-0028116353 (requires institutional sign-in at Scopus site) 54 CitationsAbstract
BACKGROUND: Allogeneic bone marrow transplantation, a sophisticated and expensive procedure, is the only curative therapy for chronic myeloid leukemia (CML). We examined the availability and appropriateness of allogeneic bone marrow transplantation for CML in 10 economically advanced countries with diverse health care systems. For each country we obtained data on the likelihood of transplantation to treat CML in patients under the age of 55 years, the length of time from diagnosis to transplantation, and the stage of disease at the time of transplantation.
METHODS: Data were collected on 9873 allogeneic bone marrow transplantations performed at 208 centers in 10 countries from 1989 through 1991. Data were acquired from transplantation registries and by means of a mailed survey of all centers and teams that did not contribute data to registries. Data on the incidence of disease were drawn from national and regional cancer registries.
RESULTS: Among the 10 countries there was a twofold difference between the lowest and highest rates of transplantation to treat CML (0.26 to 0.54 per 100,000 population per year); Swedish patients were the most likely to receive a transplant, and German patients the least likely. The median length of time from diagnosis to transplantation ranged from 6.8 to 15.4 months. In all countries, most transplantations were performed in the chronic phase of the disease, but as many as a third of patients received transplants in the less favorable accelerated or blast phase. The values for the United States fell near the middle of those for the 10 countries on all measures.
CONCLUSIONS: Our findings challenge the assumption that the United States is unique in providing broad access to high-technology treatments. On no measure of the availability or appropriateness of transplantation for CML did it surpass the other nine countries studied.
Author List
Silberman G, Crosse MG, Peterson EA, Weston RC, Horowitz MM, Appelbaum FR, Cheson BDAuthor
Mary M. Horowitz MD, MS Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Australia
Bone Marrow Transplantation
Child
Child, Preschool
Europe
Female
Health Care Rationing
Health Services Accessibility
Humans
Infant
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Male
Middle Aged
North America
Registries
Time Factors
Transplantation, Homologous
