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Previous Volume 331:1063-1067 October 20, 1994 Number 16 Next

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ABSTRACT

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.

Source Information

From the General Accounting Office, Washington, D.C. (G.S., M.G.C., E.A.P., R.C.W.); the International Bone Marrow Transplant Registry, Health Policy Institute, Medical College of Wisconsin, Milwaukee (M.M.H.); the Fred Hutchinson Cancer Research Center, Seattle (F.R.A.); and the Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Md. (B.D.C.). The views expressed herein are those of the authors and do not necessarily reflect those of the General Accounting Office, which sponsored the larger study on which this work is based.

Address reprint requests to Mr. Silberman at the Program Evaluation and Methodology Division, General Accounting Office, Rm. 5737, Washington, DC 20548.

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