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Breast Cancer and Autologous Bone Marrow Transplantation in the United States. Prof Cindy Farquhar MD MPH University of Auckland, NZ. Breast Cancer and Autologous Bone Marrow Transplant (ABMT). 18 0 ,000 US women are diagnosed with breast cancer each year 46000 US women die annually
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Breast Cancer and Autologous Bone Marrow Transplantationin the United States Prof Cindy FarquharMD MPH University of Auckland, NZ
Breast Cancer and Autologous Bone Marrow Transplant (ABMT) • 180,000 US women are diagnosed with breast cancer each year • 46000 US women die annually • 60% of women with metastatic disease die within 10 years of diagnosis
Questions • How many US women with breast cancer had autologous bone marrow transplantation ? • What was the mortality associated with the procedure ? • What was the cost of the procedure ?
Methods 1: Health Care Utilization Project Database • National Inpatient Statistics of HCUP: discharge statistics from 22 states, weighted to give national estimates, commenced 1993 • Identified women with breast cancer using ICD-9 codes • Identified women with breast cancer and ABMT using ICD-9 codes
Methods 2: American Bone Marrow Transplantation Registry • Voluntary registration of cases from clinics • Estimate that the register only collects data from 50-60% of cases • Commenced 1989
HCUP data for number of women with breast cancer who had HDC & ABMT * x 1,000 Total=19795
HCUP : Length of Stay & Charges * Hospital charges only
Number of women with breast cancer and HDC/ABMT from registry data Figures estimated to be only 50-60% - total likely to be 30,000 – 40,000
High Dose Chemotherapy and Autologous Bone Marrow or Stem Cell Transplant: Summary: • 1989-2001 approximately 30,000 – 40,000 women received an unproven, life-threatening and expensive treatment • It is estimated that at least 600 women died from the treatment • Hospital costs over 10 years are likely to be upwards of $2 billion
Acknowledgements • Agency for Healthcare Research and Quality • Claudia Steiner • Robert Wood Johnson Foundation • RAND • The Commonwealth Fund