Nav: Home

Stem cell transplantation: Chance of survival increases with number of procedures

July 29, 2019

Does the treatment success of a certain procedure depend on the number of cases in a hospital or on how often the doctors working there have already performed this procedure? In Germany, this is the subject of 8 commissions on minimum volumes awarded by the Federal Joint Committee (G-BA) to the Institute for Quality and Efficiency in Health Care (IQWiG). The IQWiG report is now available for the first indication investigated, stem cell transplantation. According to the findings, studies based on registry data show that there is indeed a correlation between treatment results and the frequency of the service provided (stem cell transplantation). This applies in particular to the survival chances of patients: The more frequently the transplantation team performs the procedure, the higher the chances of survival. In contrast, no studies could be found investigating the healthcare consequences of setting a specific minimum number of cases (25 in Germany).

Minimum Volume Regulation reformed in 2017

For about 40 years, experts have been discussing whether treatment results are better if a medical procedure is performed more frequently. In 2003, the G-BA set minimum volumes for certain plannable inpatient services for the first time: Since then, hospitals may only provide and invoice these services if they reach the set annual minimum volumes.

Since 2016, for setting minimum volumes only evidence is required "indicating a probable correlation". In 2017, the G-BA adjusted its Minimum Volume Regulation accordingly and has now commissioned IQWiG to examine the evidence in 8 indications.

Data from registries analysed

In accordance with the G-BA's commission, IQWiG searched for studies that would either allow robust conclusions to be drawn as to how the volume and quality of services provided for (autologous or allogeneic) stem cell transplantation were related, or could answer the question as to how a binding number of cases per hospital and year affected treatment success.

For the first question, IQWiG was able to include 4 observational studies (cohort studies) in the assessment, each of which had analysed patient data from international clinical registries on stem cell transplantation for malignant haematological diseases. No evidence was available for the second question, which therefore currently remains unanswered.

Only one study was highly informative

The number of patients included in the 4 studies ranged from 684 to 107,904. However, precisely the 2 largest studies were poorly informative, partly because it was unclear according to which criteria patient data had been considered in the analysis. The most informative study analysed data from 4285 patients with acute or chronic leukaemia (Loberiza 2005).

It was not possible to statistically pool the data of all studies, partly because the characteristics of the participants (e.g. age, sex, underlying disease) were too different or unknown.

Patients survived longer with a higher volume of services

Regarding mortality, the high-quality Loberiza study showed that patients survived longer after stem cell transplantation if doctors had already performed this procedure more frequently. Two studies also supported this result in terms of the volume of services provided by the hospital. However, from a methodological point of view, both of these studies were less informative.

For other outcomes, the correlations in these overall poorly informative studies were considerably weaker or even non-existent. No data at all in the 4 studies considered were available on rejection reactions in the event of a foreign donor (allogeneic stem cell transplantation) or quality of life.

It remains to be seen whether the choice of minimum volume in Germany is correct

IQWiG project manager Eva Höfer explains the results of the report: "In terms of mortality, we see a positive correlation between the volume of stem cell transplantations and treatment success. However, due to a lack of usable data, it is not possible to assess the effects of setting specific minimum volumes, for example, on patient mortality after stem cell transplantation. It therefore remains to be seen whether a case number of 25 cases per hospital location and year guarantees an optimal chance of survival for patients."

Process of report production

In July 2018, the Federal Joint Committee (G-BA) commissioned IQWiG to prepare the report in an accelerated procedure as a so-called rapid report. Interim products were therefore not published or made available for a hearing. This rapid report was sent to the contracting agency, the G-BA, in June 2019.
-end-


Institute for Quality and Efficiency in Health Care

Related Science Articles:

75 science societies urge the education department to base Title IX sexual harassment regulations on evidence and science
The American Educational Research Association (AERA) and the American Association for the Advancement of Science (AAAS) today led 75 scientific societies in submitting comments on the US Department of Education's proposed changes to Title IX regulations.
Science/Science Careers' survey ranks top biotech, biopharma, and pharma employers
The Science and Science Careers' 2018 annual Top Employers Survey polled employees in the biotechnology, biopharmaceutical, pharmaceutical, and related industries to determine the 20 best employers in these industries as well as their driving characteristics.
Science in the palm of your hand: How citizen science transforms passive learners
Citizen science projects can engage even children who previously were not interested in science.
Applied science may yield more translational research publications than basic science
While translational research can happen at any stage of the research process, a recent investigation of behavioral and social science research awards granted by the NIH between 2008 and 2014 revealed that applied science yielded a higher volume of translational research publications than basic science, according to a study published May 9, 2018 in the open-access journal PLOS ONE by Xueying Han from the Science and Technology Policy Institute, USA, and colleagues.
Prominent academics, including Salk's Thomas Albright, call for more science in forensic science
Six scientists who recently served on the National Commission on Forensic Science are calling on the scientific community at large to advocate for increased research and financial support of forensic science as well as the introduction of empirical testing requirements to ensure the validity of outcomes.
World Science Forum 2017 Jordan issues Science for Peace Declaration
On behalf of the coordinating organizations responsible for delivering the World Science Forum Jordan, the concluding Science for Peace Declaration issued at the Dead Sea represents a global call for action to science and society to build a future that promises greater equality, security and opportunity for all, and in which science plays an increasingly prominent role as an enabler of fair and sustainable development.
PETA science group promotes animal-free science at society of toxicology conference
The PETA International Science Consortium Ltd. is presenting two posters on animal-free methods for testing inhalation toxicity at the 56th annual Society of Toxicology (SOT) meeting March 12 to 16, 2017, in Baltimore, Maryland.
Citizen Science in the Digital Age: Rhetoric, Science and Public Engagement
James Wynn's timely investigation highlights scientific studies grounded in publicly gathered data and probes the rhetoric these studies employ.
Science/Science Careers' survey ranks top biotech, pharma, and biopharma employers
The Science and Science Careers' 2016 annual Top Employers Survey polled employees in the biotechnology, biopharmaceutical, pharmaceutical, and related industries to determine the 20 best employers in these industries as well as their driving characteristics.
Three natural science professors win TJ Park Science Fellowship
Professor Jung-Min Kee (Department of Chemistry, UNIST), Professor Kyudong Choi (Department of Mathematical Sciences, UNIST), and Professor Kwanpyo Kim (Department of Physics, UNIST) are the recipients of the Cheong-Am (TJ Park) Science Fellowship of the year 2016.
More Science News and Science Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Listen Again: The Power Of Spaces
How do spaces shape the human experience? In what ways do our rooms, homes, and buildings give us meaning and purpose? This hour, TED speakers explore the power of the spaces we make and inhabit. Guests include architect Michael Murphy, musician David Byrne, artist Es Devlin, and architect Siamak Hariri.
Now Playing: Science for the People

#576 Science Communication in Creative Places
When you think of science communication, you might think of TED talks or museum talks or video talks, or... people giving lectures. It's a lot of people talking. But there's more to sci comm than that. This week host Bethany Brookshire talks to three people who have looked at science communication in places you might not expect it. We'll speak with Mauna Dasari, a graduate student at Notre Dame, about making mammals into a March Madness match. We'll talk with Sarah Garner, director of the Pathologists Assistant Program at Tulane University School of Medicine, who takes pathology instruction out of...
Now Playing: Radiolab

What If?
There's plenty of speculation about what Donald Trump might do in the wake of the election. Would he dispute the results if he loses? Would he simply refuse to leave office, or even try to use the military to maintain control? Last summer, Rosa Brooks got together a team of experts and political operatives from both sides of the aisle to ask a slightly different question. Rather than arguing about whether he'd do those things, they dug into what exactly would happen if he did. Part war game part choose your own adventure, Rosa's Transition Integrity Project doesn't give us any predictions, and it isn't a referendum on Trump. Instead, it's a deeply illuminating stress test on our laws, our institutions, and on the commitment to democracy written into the constitution. This episode was reported by Bethel Habte, with help from Tracie Hunte, and produced by Bethel Habte. Jeremy Bloom provided original music. Support Radiolab by becoming a member today at Radiolab.org/donate.     You can read The Transition Integrity Project's report here.