Increasing Costs of Unrelated Donor (URD) Graft Procurement: Implications for Transplant Center Search Strategy & Financial Stewardship

While HLA-mismatched URD & cord blood (CB) grafts extend allograft access, searches & graft procurement can be expensive, especially if multiple URDs must be pursued. Double unit cord blood (dCB) grafts are also costly although domestic units are increasingly already confirmatory typed & are immediately available. We analyzed costs of URD/ CB searches with confirmatory typing (CT) & the total cost of graft procurement using NMDP charges incorporating the indirect costs of search coordinator effort. To identify trends over time, URD searches conducted 1/2022-6/2025 were evaluated; dCB searches were analyzed 9/2023-6/2025 since our Center’s adoption of dCB transplant (dCBT). 354 pts underwent URD search with donor CT, whereas 43 pts underwent CB search/CT (or hold if units previously typed at high-resolution). Accounting for the number of URDs or CB units pursued & coordinator time, total costs of URD search/CT was much higher than for search/CT (or hold) for CB units, $7,076 vs $1,693, respectively ( Table 1A ). Of the 131 pts who underwent URD transplant, a median of 8 URDs were CT’d, & a median 2 underwent workup. Median URD graft cost was $47,264, but median total procurement cost (including URD CT & workup costs) was $67,851. In the 19 pts who underwent dCBT, a median of 4 units were evaluated, with median graft cost of $106,820, & median total procurement cost of $109,362 ( Table 1B ). In an additional 82 pts who underwent URD CT with donor workup (median 2) but did not undergo URD transplant, the median total URD evaluation cost was $11,515 ( Table 1B ). Analysis of searches over time revealed URD procurement costs are increasing by an average of ∼$5000/year, whereas dCB costs have not ( Fig 2 ). Our findings have major implications for center search strategy & financial stewardship. Centers should consider the increasing costs of URD CT +/- workup, & the recently instituted fees for donor collection date changes, especially if the pt is not transplanted, as many of these costs may not be reimbursed. URD procurement cost is increasing & the indirect costs of coordinator time will increase if multiple URDs must be pursued for workup. Although dCB grafts are expensive, benefits are realized as CT costs are not increasing, domestic units are now often already typed at high-resolution & have immediate availability. Interestingly, our data suggest that single CB units may be more cost-effective alternatives to URD grafts. Future analyses should model potential cost savings associated with refinements in search strategy. Moreover, modeling in pts suitable for CBT should assess the impact of immediate transplant vs the cost of delay while pursuing an URD, especially in non-European pts who have a high rate of donor unavailability (Fingrut et. al., Blood Adv 2024).