Cord blood bank program struggling amid costs and declining usage

When Laura Brinkley gave birth to a baby girl last August at Mercy Medical Center, she donated the blood from the umbilical cord in the hope that the stem cells it carried could treat someone with a debilitating disease such as leukemia or sickle-cell anemia.

Deciding to donate was easy for Brinkley, who happens to be a nurse. She especially wanted to help fellow African-Americans, who have a harder time than other racial groups finding a stem cell match.

“Once the doctor explained it to me I was on board,” she said. “I wanted to be able to help.”

Similarly to bone marrow, stem cells extracted from the blood of an umbilical cord can be used to treat and cure more than 80 life-threatening diseases by helping to rebuild the immune system. Cord blood is often preferable to bone marrow because it is easier to match and has a significantly lower risk of the cells’ being rejected. But it is often thrown out as medical waste after a baby’s birth.

To increase access to stem cells and their use, the federal government in 2005 created public banks like the one at Mercy that Brinkley donated to. The 19 banks still open have seen success in the units of blood collected but have struggled financially. Some others closed.

The banks collect cord blood at no cost to donors and charge fees only when it’s taken for medical care, the number of patients withdrawing the blood for treatment is declining.

The U.S. Department of Health and Human Services, concerned about the banks’ performance, commissioned the RAND Corp. to research how to make the banks, including two in Baltimore — at Mercy Medical Center and St. Agnes Hospital — more financially stable. The health agency spends $60 million to $70 million a year to maintain the cord blood program, which includes paying subsidies to some of the banks. It costs $1 million to $6 million to run a single bank, RAND found.

The RAND researchers, who released their study results in September, found that although the banks faced obstacles such as competition from private blood banks and high operating costs, there were ways to restructure the cord blood program to make it more viable. The federal health department’s Health Resources and Services Administration is reviewing the findings to determine future policy directions.

“There is a lot of use to improving the use of cord blood,” said Kandice Kapinos, the study’s lead author and an economist at Rand. “These banks serve an important purpose.”

Kapinos and her colleagues determined that competition from both private and international cord blood banks contributed to the problems the American banks face. International banks now provide about 24 percent of the units of blood used in the United States compared to 13 percent in 2004, the researchers noted.

In addition, fewer doctors are using cord blood stem cells. Transplants of other types of stem cells, such as those found in bone marrow, have been rising; there were 8,700 in 2015, up from 7,100 in 2010. During that same time period, the number of stem-cell transplants using cord blood declined to 728 from 822, the RAND researchers found.

The cost of using cord blood stem cells may be a deterrent. Some transplant doctors told RAND researchers that using cord blood stem cells was a last resort.

Hospital stays are longer and more costly because cord blood stem cells take longer to start growing and making healthy cells in a patient’s body than stem cells from other sources. The hospital costs for a bone marrow transplant range from an average of $68,382 to an average of $154,005. The average cost of a cord blood stem-cell transplant is $262,972.

But Kapinos said it is unclear if cord blood costs more, because the cost of bone marrow is not readily available. Banks charge transplant centers on average about $36,000 for a unit of cord blood. It is possible the overall costs of the two procedures are not all that different, she said.

Banks also are storing cord blood with low stem cell counts. These samples are less likely to be used by doctors, and banks only collect money on cord blood that is used.

RAND said that there is still good reason to keep the public cord banks. In particular, it makes the stem cells available to minorities and other underserved groups.

The RAND researchers said the federal government could take many steps to improve the viability of public banks. They suggested more banks could be set up in minority communities, since there is a need for cord blood stem cells to treat certain diseases, such as sickle-cell anemia, that disproportionately affect these communities.

Federal health authorities also could increase the number of stem cells required to be present in banked blood. This would help eliminate blood samples with low stem cell counts that are never used. Another option would be to charge a premium for samples with higher stem cell counts.

At Mercy Medical Center, doctors are doing what they can to increase the use of the public bank housed there and the volume of cord blood collected. The hospital is working to better educate pregnant women about the procedure and the bank, said Dr. Robert Atlas, chair of the hospital’s department of obstetrics and gynecology.

“It is totally underutilized,” he said.

One reason women don’t donate their babies’ cord blood, Atlas said, is that they are choosing to delay clamping the umbilical cord after birth so their newborns get more of the blood. Doing that saps too much blood from the cord to make it worth storing.

Some women are also turned off by the tedious paperwork, including listing their medical history, that must be filled out to donate the blood, he said.

Charis Ober, executive director and founder of the Save the Cord Foundation, said there is a need to keep public cord banks viable.

“Many times it is the only medical option for treatment,” Ober said. “People can’t get matched otherwise.”

Kristen Holman, 32, of Rosedale, who delivered a baby girl at Mercy in August, said the thought of helping someone prompted her to donate her baby’s umbilical cord.

“I just felt like there was no other option,” she said. “If we were not going to keep it, we would want it to be put to use for someone else. If I could help somebody else’s child one day that would be great.”

amcdaniels@baltsun.com

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