Karl Frauendorfer

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Prof. em. Dr.
Last Name
Frauendorfer
First name
Karl
Email
karl.frauendorfer@unisg.ch
Phone
+41 71 224 2105
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    Item type:Publication,
    Hematopoietic Stem Cell Transplantation: A Global Perspective
    (American Medical Association, 2010-04-28)
    Gratwohl, Alois
    ;
    Baldomero, Helen
    ;
    Aljurf, Mahmoud
    ;
    Pasquini, Marcelo
    ;
    Bouzas, Luis
    Context Hematopoietic stem cell transplantation (HSCT) requires significant infrastructure. Little is known about HSCT use and the factors associated with it on a global level. Objectives To determine current use of HSCT to assess differences in its application and to explore associations of macroeconomic factors with transplant rates on a global level. Design, Setting, and Patients Retrospective survey study of patients receiving allogeneic and autologous HSCTs for 2006 collected by 1327 centers in 71 participating countries of the Worldwide Network for Blood and Marrow Transplantation. The regional areas used herein are (1) the Americas (the corresponding World Health Organization regions are North and South America); (2) Asia (Southeast Asia and the Western Pacific Region, which includes Australia and New Zealand); (3) Europe (includes Turkey and Israel); and (4) the Eastern Mediterranean and Africa. Main Outcome Measures Transplant rates (number of HSCTs per 10 million inhabitants) by indication, donor type, and country; description of main differences in HSCT use; and macroeconomic factors of reporting countries associated with HSCT rates. Results There were 50 417 first HSCTs; 21 516 allogeneic (43%) and 28 901 autologous (57%). The median HSCT rates varied between regions and countries from 48.5 (range, 2.5-505.4) in the Americas, 184 (range, 0.6-488.5) in Asia, 268.9 (range, 5.7-792.1) in Europe, and 47.7 (range, 2.8-95.3) in the Eastern Mediterranean and Africa. No HSCTs were performed in countries with less than 300 000 inhabitants, smaller than 960 km2, or having less than US $680 gross national income per capita. Use of allogeneic or autologous HSCT, unrelated or family donors for allogeneic HSCT, and proportions of disease indications varied significantly between countries and regions. In linear regression analyses, government health care expenditures (r2 = 77.33), HSCT team density (indicates the number of transplant teams per 1 million inhabitants; r2 = 76.28), human development index (r2 = 74.36), and gross national income per capita (r2 = 74.04) showed the highest associations with HSCT rates. Conclusion Hematopoietic stem cell transplantation is used for a broad spectrum of indications worldwide, but most frequently in countries with higher gross national incomes, higher governmental health care expenditures, and higher team densities.
    Type:journal article
    Journal:Journal of the American Medical Association (JAMA)
    Volume:303
    Issue:16
    DOI:10.1001/jama.2010.491
    URI:https://www.alexandria.unisg.ch/handle/20.500.14171/96560
    Scopus© Citations 602
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    Item type:Publication,
    Changes in the use of hematopoietic stem cell transplantation: a model for diffusion of medical technology
    (Ferrata Storti Foundation, 2010-04-01)
    Gratwohl, Alois
    ;
    Schwendener, Alvin
    ;
    Baldomero, Helen
    ;
    Gratwοhl, Μichael
    ;
    Apperley, Jane
    Background Innovations in hematology spread rapidly. Factors affecting the speed of introduction, international diffusion, and durability of use of innovations are, however, poorly understood. Design and Methods We used data on 251,106 hematopoietic stem cell transplants from 591 teams in 36 European countries to analyze the increase and decrease in such transplants for breast cancer and chronic myeloid leukemia and the replacement of bone marrow by peripheral blood as the source of stem cells as processes of diffusion. Regression analyses were used to measure the quantitative impact of defined macro- and microeconomic factors, to look for significant associations (t-test), and to describe the coefficient of determination or explanatory content (R2). Results Gross national income per capita, World Bank category, team density, team distribution, team size, team experience and, team innovator status were all significantly associated with some or all of the changes. The analyses revealed different patterns of associations and a wide range of explanatory content. Macro- and micro-economic factors were sufficient to explain the increase of allogeneic hematopoietic stem cell transplants in general (R2 = 78.41%) and for chronic myeloid leukemia in particular (R2 = 79.39%). They were insufficient to explain the changes in stem cell source (R2 =26.79% autologous hematopoietic stem cell transplants; R2 = 9.67% allogeneic hematopoietic stem cell transplants) or the decreases in hematopoietic stem cell transplants (R2 =10.22% breast cancer; R2=33.17% chronic myeloid leukemia). Conclusions The diffusion of hematopoietic stem cell transplants is more complex than previously thought. Availability of resources, evidence, external regulations and, expectations were identified as key determinants. These data might serve as a model for diffusion of medical technology in general.
    Type:journal article
    Journal:Haematologica
    Volume:95
    Issue:4
    DOI:10.3324/haematol.2009.015586
    URI:https://www.alexandria.unisg.ch/handle/20.500.14171/96634
    Scopus© Citations 41