My daughter is pregnant and she, like many pregnant women, has been offered the possibility of private umbilical cord blood banking. She might ask my opinion.
I get offers to put oodles of information and brochures in my waiting room for expectant parents (I don’t, since I no longer deliver babies). Absent information directly proffered by obstetricians, women are targeted by private cord banking companies through direct to pregnant –consumer advertising in prenatal magazines, web sited and the peer pressure established among pregnant women and their families as they traverse the studies, tests and tribulations of their gestation. So when that final push for a healthy baby is made by the Mom (or by the obstetrician if she has a C Section), should there be one more painless procedure performed? Should cord blood with its special stem cells be removed and sent for private storage for the next 20 years just in case it can be used as “biologic insurance” against a future disease of the child or a sibling?
A recent review that addressed cost-effectiveness of this procedure was published in the Journal of Obstetrics and Gynecology. They cited a survey by the American Society for Blood and Bone Marrow Transplantation of private umbilical cord blood banks; of approximately 460,000 private banked cord blood units, only 99 had been shipped for transplantation. Another survey of 93 pediatric specialists who perform the transplantations in the United States and Canada reported that only 49 transplants had been done in the donor child or its siblings; moreover in 36 of the instances, there was a known disease in a sibling and the blood had been collected preemptively.
There are several problems that may cause this minimal use: Some of the samples were contaminated by bacteria, others were improperly labeled. The literature indicates that 25% to 56% of cord blood specimens could not be used either because the stem cell count within the blood was too small or because of problems with the blood’s storage. Then there is the issue of whether the transplantation will help the disorder for which it is given. Currently the estimate of probability of future need for cord blood for treatment of the donor child is 1 in 2,500 or 0.04%. (It is currently used for bone marrow failure which can cause aplastic anemia or for blood malignancies such as leukemia as well as certain metabolic disorders.) However, if the donor child does develop leukemia there is concern about transplanting his or her own stem cells since they may have the propensity to become malignant. This would not be a problem if a sibling needs the stem cells obtained from the cord blood of a presumably healthy donor child. Hence the probability of using umbilical cord blood for a sibling is a little greater, but still rare, 1 in 1,425 or 0.07%.
The cost of private umbilical cord banking and storage for 20 years is high and according to Web sites ranges from $3,620 and $4,170.
The final assessment in what the statisticians call “base case analysis” (sorry but you might as well learn some new terms) is that private umbilical cord blood banking results in a lifetime gain of 0.0026 years. And if the cost is $3,620 (compared to $0 if not done) this amounts to an additional expenditure of $1,374,246 per life year saved.
The only way it might be “cost effective” (a term we will hear more and more as we strive to reduce the cost of health care) is if the likelihood of a child needing its own stem cell transplant was greater than 1 in 110 or of the likelihood of a sibling needing a stem cell transplant rose to 1 in 43…and/or the cost of umbilical cord blood banking was reduced to $262 (or less than 7% of what it is now).
The American College of Obstetricians and Gynecologists and The American Association of Pediatrics have already made statements recommending against private cord blood banking unless there is a family member with a known diagnosis that could be treated by umbilical cord blood. Despite this many patients still want to “play it safe” probably because they don’t understand the statistics and overestimate the probability of the need for its use. (And the data may not be appropriately explained.) Let’s also acknowledge the medical magic implied in the term “stem cells”. If we can get them for our progeny, it can’t be unnecessary or too expensive. Obstetricians are placed in a difficult position and often have to accommodate their patient’s request. Dissuading is harder than accommodating.
The cost benefit for use of umbilical cord blood transplants would greatly benefit from a program of public cord banking. But alas this is not available in most areas of the United States.
Bottom line (and I’ll try to convince my daughter)…private umbilical cord blood banking is cost effective only for families with rare blood diseases in which a child has a very high risk of requiring a stem cell transplant. The for-profit private cord banking facilities are unlikely to stress these facts.