1. Breast Cancer and Autologous Bone Marrow Transplantation in the United States Prof Cindy Farquhar MD MPH University of Auckland, NZ

2. 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

3. 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 ?

4. 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

5. 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

6. HCUP data for number of women with breast cancer who had HDC & ABMT 199319941995199619971998199920002001 No. with Breast Ca* 519510529520548571568580618 No. with HDC+ ABMT 422538635243562964244850451024313163 BC and HDC+ ABMT 2132243230733312303027692033461 563 * x 1,000Total=19795

7. HCUP: In Hospital Mortality 199319941995199619971998199920002001 In patient mortality (%) 3.73.62.02.91.91.81.31.23.5 No. of deaths 78856096734825520 Median age 4445 47 4546

8. HCUP : Length of Stay & Charges 199319941995199619971998199920002001 Median length of stay 242320 192021 Median Charges ($) * 103, 924 103, 540 87,0 62 85,3 05 82,8 81 78,4 68 71,7 60 90,0 29 107, 412 * Hospital charges only

9. HDC/ABMT 1993-2001 for Breast Cancer

10. Number of women with breast cancer and HDC/ABMT from registry data YearNumbers 1989272 1990332 1991743 19921212 19931459 19941963 19952466 19962978 1997333 19983478 19991876 2000567 2001231 Total18140 Figures estimated to be only 50-60% - total likely to be 30,000 – 40,000

11. 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

12. Acknowledgements Agency for Healthcare Research and Quality Claudia Steiner Robert Wood Johnson Foundation RAND The Commonwealth Fund