The Business of Cellular Therapy and Hematopoietic Stem Cell Transplantation

Abstract

Hematopoietic stem cell transplantation (HSCT) is extremely complex and expensive, requiring significant personnel, pharmaceutical, supportive, and patient/family resources. As indications for transplantation multiplied and transplant-related mortality declined, HSCT utilization expanded with a dramatic increase in the number of both autologous and allogeneic procedures performed over the past decade.

HSCT has demonstrated efficacy for the treatment of selected malignancies, as well as for immunodeficiency, bone marrow failure, and infiltrative disorders. Development of reduced intensity-conditioning regimens has allowed successful treatment of older patients and those with comorbidities that would previously have been deemed ineligible. The expansion beyond human leukocyte antigen (HLA)-identical sibling allogeneic HSCT to unrelated donor transplants as well as alternative donors, including unrelated cord blood transplants and related haploidentical donors, has resulted in donor availability for nearly all patients in need.

The increase in utilization of HSCT procedures has been associated with a dramatic increase in overall costs. Therefore, it remains critical for providers and health systems to assure that adequate reimbursement is obtained to cover the costs of the individual procedures, costs associated with the defined incident of care, and the potential associated with medical complications and sequelae.

Contracting for HSCT services is a complex issue and understanding the reimbursement variability between governmental and private payers is a necessity. The Affordable Care Act’s impact on HSCT availability is significant.

High-quality outcomes for HSCT patients have always been a goal of transplant providers and their teams. Increasingly, there has been national attention on outcomes necessary to maintain eligibility within third-party payers’ network facilities and, more recently, for governmental payer reimbursement.

It is anticipated that quality initiatives will be increasingly scrutinized with a major focus on survival, quality of life, and the presence or absence of clinical comorbidities. Efficient health-care delivery via care pathways will also be examined, and their utilization will increasingly influence reimbursement, as well as maintaining center of excellence designation.