The Health Information and Quality Authority (HIQA) has published a Health Technology Assessment (HTA) on the repatriation of paediatric haematopoietic stem cell transplant (allogeneic haematopoietic stem cell transplant (HSCT)) services to Ireland. This HTA was undertaken following a request from the HSE.

The HTA examined the choice of treatment location for children with certain rare, inherited conditions who require stem cell transplants. HSCT treatment for these patients has typically been provided in the UK and funded through the HSE's Treatment Abroad Scheme. These conditions include inborn errors of metabolism, inborn errors of immunity and haemoglobinopathies, conditions which disproportionately affect ethnic minorities within Ireland. The advice in this HTA will inform a decision by the HSE on whether to repatriate treatment and, therefore, to provide HSCT in Ireland for these children. 

The HSE has an accredited HSCT service in Children’s Health Ireland (CHI) at Crumlin. Children with other conditions, such as leukaemia, receive their transplant at this location. HIQA found that repatriating HSCT services for children who currently receive the treatment in the UK would potentially double the number of paediatric allogeneic (donor derived) HSCT procedures that would be carried out in Ireland every year. 

HIQA found that while demand for HSCT will vary from year to year, on average, the HSE would have sufficient bed capacity to accommodate the patients currently treated in the UK. HIQA’s estimates take account of the greater number of dedicated transplant beds that will be available when services move to the new National Children’s Hospital. 

However, the ability to repatriate the service would rely on the recruitment of additional staff, such as skilled nursing staff and support staff, across a range of disciplines. HIQA noted that phased approach to implementation may be required to support the build-up of sustainable capacity within the service. While there is substantial uncertainty in relation to costs, it was estimated that repatriating care for these patients could lead to cost reductions for the HSE.

HIQA’s Deputy CEO and Director of Health Technology Assessment Dr Máirín Ryan, said: “When a child needs to undergo a stem cell transplant this experience is incredibly stressful for families. The need to travel abroad increases the stress further, with children and their parents having to remain abroad for periods of between two and six months. This means that families are separated from one another for long periods. Our assessment found that repatriation of stem cell transplants to Ireland would reduce the financial, logistical and emotional burden that these families face.”

You can find the HTA at the link at the top of the page.
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For further information please contact:
Marty Whelan, Head of Communications and Stakeholder Engagement 085 805 5202 / mwhelan@hiqa.ie

Notes to the editor:

• The Health Information and Quality Authority (HIQA) has today published the following document: Repatriation of paediatric haematopoietic stem cell transplant services to Ireland: A Health Technology Assessment. 
• The HTA analysed the budget impact, organisational, patient, social, legal and ethical issues, associated with providing HSCT for these conditions in Ireland rather than abroad. 
• This HTA was requested by the National Paediatric Public Health Lead in the Health Service Executive. It is supported by specialist clinicians in Children’s Health Ireland.
• A HSCT or haematopoietic stem cell transplant (sometimes known as a bone marrow transplant), is a treatment whereby a person is given a transfusion of healthy blood stem cells from their own body or from a donor. This HTA examines allogeneic transplants, which involve receiving stem cells from a donor. Donors are often siblings or close family members. 
• Haematopoietic stem cell transplantation is not a suitable treatment for every patient with an inborn error of metabolism, inborn error of immunity or haemoglobinopathy. Its suitability depends on the form and severity of the condition and the availability of a suitable donor.