within the constraints of the available resources as well as the constraints of the differences in the degree of difficulty in finding suitably histocompatible cord blood units.

The goal of efficiency will thus need to be balanced against concerns of equity. Equity is a way of describing the potential differences in the benefits received from HPC transplantation among identifiable subgroups in the population (e.g., different racial or ethnic groups).

The efficiency of the cord blood inventory should be assessed in terms of the ability of the inventory—as one potential source of allogeneic HPCs—to increase the benefits in terms of the length and quality of life of potential transplant recipients, again given the constraints of the available resources and the various degrees of difficulty in finding suitably histocompatible cord blood units.

An inventory created to maximize efficiency within the bounds of the definitions given above would require the expenditure of an amount equal to the unit of benefit gained. Addressing equity concerns would produce variation in this cost per unit of benefit across racial and ethnic groups. It is not clear what level of variation across such groups would best promote increases in equity. The Cord Blood Center proposed in Chapter 7 should thus routinely collect and evaluate data on the distribution of benefits and the cost per unit of benefit across different groups of the population. These results should be reported routinely to the proposed national oversight board to inform decision making about the tradeoffs between equity and efficiency in the proposed National Cord Blood Bank Program.

The inventory should consist of cord blood units that meet consistent standards for regulatory compliance and thus ensure that clinical transplant physicians are confident of the quality of those units used for clinical transplantation. As discussed in Chapter 4, these standards should be flexible enough to accommodate advances in the field of cord blood transplantation, and thus, the cord blood inventory policy will need to have flexibility built into it.

The following list reflects specific principles that will allow the proposed national oversight board to balance the principles of efficacy and efficiency. The inventory, therefore, should:

  • Reflect the current needs and indications for clinical hematopoietic stem cell transplantation and retain flexibility to accommodate and address emerging and evolving trends in and technologies for cord blood unit selection, ex vivo expansion, and transplantation of cord blood units.

  • Ensure the availability for research purposes of cord blood units that are not (or that are no longer) suitable for clinical use.

  • Be appropriately balanced with regard to the diversity of the units from different ethnic and racial groups represented in the inventory and the



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