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Practical allocation system for the distribution of specialised care during cellular therapy access scarcity
  1. Andrew Hantel1,
  2. Gregory A Abel2,
  3. Mark Siegler3
  1. 1 Department of Medicine, Section of Hematology/Oncology and The MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, Illinois, USA
  2. 2 Division of Population Science and Hematologic Malignancies, Dana Farber Cancer Institute, Boston, Massachusetts, USA
  3. 3 Department of Medicine, The MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, Illinois, USA
  1. Correspondence to Dr Andrew Hantel, Department of Medicine, Section of Hematology/Oncology, The University of Chicago, Chicago IL 60637, USA; ahantel{at}medicine.bsd.uchicago.edu

Abstract

Novel cellular therapy techniques promise to cure many haematology patients refractory to other treatment modalities. These therapies are intensive and require referral to and care from specialised providers. In the USA, this pool of providers is not expanding at a rate necessary to meet expected demand; therefore, access scarcity appears forthcoming and is likely to be widespread. To maintain fair access to these scarce and curative therapies, we must prospectively create a just and practical system to distribute care. In this article, we first review previously implemented medical product and personnel allocation systems, examining their applicability to cellular therapy provider shortages to demonstrate that this problem requires a novel approach. We then present an innovative system for allocating cellular therapy access, which accounts for the constraints of distribution during real-world oncology practice by using a combination of the following principles: (1) maximising life-years per personnel time, (2) youngest and robust first, (3) sickest first, (4) first come/first served and (5) instrumental value. We conclude with justifications for the incorporation of these principles and the omission of others, discuss how access can be distributed using this combination, consider cost and review fundamental factors necessary for the practical implementation and maintenance of this system.

  • allocation of health care resources
  • clinical ethics
  • health personnel
  • public policy
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Footnotes

  • Contributors AH was involved in overall concept and design, drafting of the manuscript, critical revision of the manuscript and important intellectual content. MS was involved in overall concept and design, drafting of the manuscript, critical revision of the manuscript and important intellectual content. GAA was involved in concept and design of portions of the manuscript, drafting of the portions of the manuscript, critical revision of the entire manuscript and important intellectual content. All authors had final approval of the submitted manuscript and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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