Hematopoetic Stem Cell Transplantation: Statistical Analysis
Type
fundamental research project
Start Date
01 July 2004
End Date
31 December 2014
Status
ongoing
Keywords
Hematopoietic stem cell transplantations
statistical analysis
macroeconomic factors
trends
changes
Description
The University Hospital Basel investigates changes in the use of hematopoietic stem cell transplantations (HSCTs). The ior/cf-HSG supports these efforts by means of
statistical analyses. 'Evidence, expectations, economics, and external regulations' prove decisive among the explanatory variables.
Member contributor(s)
Gratwohl, Michael
Funder(s)
Topic(s)
Development (trends and changes) of the number of hematopoietic stem cell transplantations across Europe and worldwide with respect to medical indication
ressources
and regulation.
Method(s)
Data collection
statistical analyses
Range
HSG Internal
Range (De)
HSG Intern
Eprints ID
7300

Filters

Reset filters

Settings
Now showing 1 - 5 of 5
  • Publication
    Quantitative and Qualitative Differences in Use and Trends of Hematopoietic Stem Cell Transplantation : A Global Observational Study
    (Ferrata Storti Foundation, 2013-08)
    Gratwohl, Alois
    ;
    Baldomero, Helen
    ;
    Gratwοhl, Μichael
    ;
    Aljurf, Mahmoud
    ;
    Bouzas, Luis
    ;
    Horowitz, Mary
    ;
    Kodera, Yoshihisa
    ;
    Lipton, Jeff
    ;
    Iida, Minako
    ;
    Pasquini, Marcelo
    ;
    Passweg, Jakob
    ;
    Szer, Jeff
    ;
    Madrigal, Alejandro
    ;
    Frauendorfer, Karl
    ;
    Niederwieser, Dietger
    After 55 years since its first publication stem cell transplantation is considered the optimal treatment option for specific hematological and non-hematological diseases. There is considerable interest in understanding differences of its use and trends at a global level. This analysis aims at analyzing differences in indications, world regions and macroeconomic factors over a three year period. Data from 2006-2008 were obtained from WBMT member registries and from transplant centers in countries without registries, pooled and duplicate reporting removed. Population and macroeconomic data were collected from the World Bank and from the International Monetary Fund. Transplant rates were analyzed by indication, donor type, country, and World Health Organization regional offices areas and related to selected health care indicators using single and multiple linear regression analyses. A total of 146,808 patients after stem cell transplantation were reported by 1,411 teams from 72 countries over 5 continents. Annual number of transplants (+11%) steadily increased, but preferentially in high (p=0.02) and not in low or medium income countries. Highest increase was observed in the Asia Pacific region and, among alllogeneic transplants, in myelodysplasia, chronic lymphocytic and acute leukemias, nonmalignant diseases (>+21%). Among autologous transplantation autoimmune and lymphoproliferative diseases increased. A clear negative trend was seen in allogeneic for chronic myelogenous leukemia and in autologous transplants for leukemias and solid tumors. Transplant rates (p< 0.01), donor type (p< 0.01) and disease indications (p < 0.01) differed significantly between countries and regions and were associated with Gross National Income/capita (p < 0.01) but showed a wide variation of explanatory content by donor type and disease indication. An increase of stem cell transplant activity is observed worldwide but with significant regional differences. The preferential increase in high income country indicates a widening gap between low and high income countries.
    Type: journal article
    Journal: Haematologica
    Volume: 98
    Issue: 8
    DOI: 10.3324/haematol.2012.076349
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/88928
    Scopus© Citations 93
  • 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
    ;
    Niederwieser, Dietger
    ;
    Frauendorfer, Karl
    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 35
  • Publication
    Predictability of hematopoietic stem cell transplantation rates
    (Il Pensiero Scientifico, 2007-12-01)
    Gratwohl, Alois
    ;
    Baldomero, Helen
    ;
    Schwendener, Alvin
    ;
    Gratwοhl, Μichael
    ;
    Apperley, Jane
    ;
    Niederwieser, Dietger
    ;
    Frauendorfer, Karl
    Background and Objectives Hematopoietic stem cell transplantation (HSCT) is a complex and expensive procedure. Trends in the use of this procedure have appeared erratic in the past. Information on future needs is essential for health care administrators. Design and Methods We analyzed the evolution of transplant rates, e.g. numbers of transplants per 10 million inhabitants, in Europe from 1990 to 2004 for all major disease categories and used Gross National Income (GNI) per capita, team density (numbers of teams per 10 million inhabitants) and team distribution (numbers of teams per 10,000 km2) to measure the impact of economic factors in participating countries. Trends were compared by regression analyses, and countries were grouped by World Bank definitions into high, middle and low income categories. Results Transplant rates increased over time with nearly linear trends, in clear association with GNI per capita (R2=0.72), and distinct by World Bank category within a narrow window of variation for both autologous HSCT (R2=0.95, 0.98 and 0.94 for high, middle and low income categories, respectively) and allogeneic HSCT (R2=0.99, 0.96 and 0.95 for high, middle and low income categories, respectively) when breast cancer (autologous) and chronic myeloid leukemia (allogeneic) were excluded. Team density (R2=0.72) and team distribution (R2=0.51) were also associated with transplant rates. Interpretation and Conclusions Transplant rates for HSCT in Europe are highly predictable. They are primarily influenced by GNI per capita. The absence of saturation and a nearly linear trend indicate that infrastructure lags behind medical needs. Isolated changes in single disease entities can easily be recognized.
    Type: journal article
    Journal: Haematologica
    Volume: 92
    Issue: 12
    URL: https://www.ncbi.nlm.nih.gov/pubmed/18055992
    DOI: 10.3324/haematol.11260
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/79896
    Scopus© Citations 31
  • Publication
    Hematopoietic Stem Cell Transplantation: A Global Perspective
    (American Medical Association, 2010-04-28)
    Gratwohl, Alois
    ;
    Baldomero, Helen
    ;
    Aljurf, Mahmoud
    ;
    Pasquini, Marcelo
    ;
    Bouzas, Luis
    ;
    Yoshimi, Ayami
    ;
    Szer, Jeff
    ;
    Lipton, Jeff
    ;
    Schwendener, Alvin
    ;
    Gratwοhl, Μichael
    ;
    Frauendorfer, Karl
    ;
    Niederwieser, Dietger
    ;
    Horowitz, Mary
    ;
    Kodera, Yoshihisa
    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 531
  • Publication
    The EBMT Activity Survey 2009: Trends over the Past 5 Years
    (Nature Publishing Group, 2011-02-28)
    Baldomero, Helen
    ;
    Gratwohl, Alois
    ;
    Gratwοhl, Μichael
    ;
    Tichelli, André
    ;
    Niederwieser, Dietger
    ;
    Madrigal, Alejandro
    ;
    Frauendorfer, Karl
    Six hundred and twenty-four centers from 43 countries reported a total of 31?322 hematopoietic SCT (HSCT) to this 2009 European Group for Blood and Marrow Transplantation (EBMT) survey with 28?033 first transplants (41% allogeneic, 59% autologous). The main indications were leukemias (31%; 92% allogeneic), lymphomas (58%; 12% allogeneic), solid tumors (5%; 6% allogeneic) and non-malignant disorders (6%; 88% allogeneic). There were more unrelated than HLA-identical sibling donors (51 vs 43%) for allogeneic HSCT; the proportion of peripheral blood as stem cell source was 99% for autologous and 71% for allogeneic HSCT. Allogeneic and autologous HSCT continued to increase by about 1000 HSCT per year since 2004. Patterns of increase were distinct and different. In a trend analysis, allogeneic HSCT increased in all World Bank Categories (P=0.01, two sided; all categories), autologous HSCT increased in middle- (P=0.01, two sided) and low-income (P=0.01, two sided) countries. EBMT practice guidelines appeared to have an impact on trend, with a clear increase in absolute numbers within the categories ‘standard' and ‘clinical option' for both allogeneic and autologous HSCT (P=0.01, two sided; for both allogeneic and autologous HSCT) and a clear decrease in autologous HSCT for the ‘developmental' and ‘generally not recommended' indications (P=0.01, two sided). These data illustrate the status and trends of HST in Europe.
    Type: journal article
    Journal: Bone Marrow Transplantation
    Volume: 46
    Issue: 4
    DOI: 10.1038/bmt.2011.11
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/94461
    Scopus© Citations 131