August 8, 2020

The Niche

Knoepfler lab stem cell blog

One of the most common questions that patients have asked me over the last decade is, “how much do stem cells cost?” They actually ask seem to want to know more specifically how much the treatments should cost. To try to authoritatively answer this we need data from the present and past along with expert perspectives.

Stem cells cost & questions

These kinds of questions on what are common and reasonable prices have continued in 2020. However, the types of queries have also evolved as things have gotten more complex in the regenerative and cell therapy space. There are many layers to the question of cost, which I cover here in today’s article.

This post is the most comprehensive look at stem cell treatment cost and costs of related therapies that I’ve seen on the web, especially factoring in our inclusion of historical polling data from past years here on The Niche.

Furthermore, it encompasses the prices of other biologics therapies including platelet-rich plasma (PRP) and new purported exosome therapy as well as issues related to insurance, fundraising, and approaches to being a smart consumer. Keep in mind that almost all stem cell therapies outside the bone marrow/hematopoietic sphere are not FDA-approved and most lack rigorous data to back them up so this post is definitely not recommending you get them. I advise against it, but many people still want info on cost.

Let’s get started.

Stem Cell Treatment Cost 2020 The Niche
Stem Cell Treatment Cost 2020 Polling The Niche.

Patient questions on stem cell cost

After more than a decade of blogging about stem cells from just about every angle, it’s interesting to consider trends in the types of questions I get asked. Beyond cost, I also often get asked How much of a stem cell treatment price does insurance cover? Of course, insurance (or lack thereof) directly bears on cost too. I’ll get more into insurance later in the post.

Polling stem cell injections number
Polling stem cell injections number, The Niche.

In a way it’s not so surprising that cost is so much on people’s minds now for a few reasons.

First, as compared to many years back, people now view stem cell injections as a more everyday thing. Stem cell therapy is often available just down the street at a local strip mall. Back in 2010 and in the 5 or so years after that, people instead more often viewed stem cells as some amazing thing out of reach to them at that time. Now people view stem cell offerings through the lens of consumers.

Sadly, another major part of the reason for the change in perceptions of stem cell treatments is the tidal wave of stem cell clinics from coast to coast in the US selling unproven and sometimes dangerous offerings.

At the same time, some universities and large medical centers also sell stem cell or similar offerings that aren’t proven. I’m worried that that number may be increasing too and patients who may be paying there for unproven stem cells way at the very high end of the cost spectrum, sometimes above $100K.

Other stem cell suppliers and clinics market stem cell-related “stuff” that isn’t real stem cells such as platelet rich plasma or PRP (see my comprehensive guide to PRP including a helpful infographic here) or injections of often “dead” perinatal stem cell products.

The cost of PRP is typically half or even much less than that of a stem cell injection (more below).

For all these reasons about once every year or two, I do polling asking the readers of The Niche here about their experiences.

I’ve done the polling again now in 2020 in a more comprehensive form.

2020 data: why do stem cells cost so much?

To have a sense of cost, we need to ask patients certain questions. How much did you pay per injection? How many injections did you get? Where did you get them?

Keep in mind that the total cost of stem cell “therapy” is the product of the cost per injection times the # of injections. For instance, if a stem cell injection costs $8,000 and you get 10 injections, your total cost is $80,000.

Unfortunately, the unproven stem cell clinics generally do not volunteer data on how much they charge. They also often encourage patients to get many injections.

Our 2020 polling data (you can still participate and I will update this) for stem cell treatments are in the graphic above. Here are some highlights.

The self-reported responses on cost for stem cell treatments, as indicated by respondents to our 2020 polling, suggest the price has gone up.

While the most common answer last year in 2019 was $2,501-$5,000, in 2020 the most common response was “$10,001-$20,000”, while $2,501-$5,000 was close behind.

The percentage of people paying the most, more than $100,000, was only slightly (probably non-significantly) higher in 2020, but both in 2019 and 2020 the percentage of people paying over $100K was much higher than in 2018 polling.

Keep in mind this is the cost per injection so how many injections do patients typically get? While the number of injections reported most commonly was “1” in both 2019 and 2020, in this year of 2020, the second most common answer was 6-10 injections, a big boost from 2019. Again, more injections end up multiplying things up to boost the total cost. Only a few people in the polling had many injections, but in my view it is still striking to see anyone say they’ve received more than 20 stem cell injections.

PRP cost exosome cost
The Niche PRP cost, exosome cost polling.

What is the cost of PRP therapy?

While I don’t have historical data on PRP, this new 2020 polling provides a baseline and can be compared to other resources on PRP. For instance see this interview I did with UCSF’s Dr. Drew Lansdown, who has studied PRP cost.

I didn’t get that many responses here, but most people said they paid less than $2,000 for it, which is much cheaper than stem cell injections. Only 5% of people said they paid more than $10,000 for PRP. While most often cheaper than stem cells, if PRP doesn’t work for many things, that can still be a big waste of money.

There was also an interesting paper published in February 2020 by Dr. Lansdown about the cost of PRP: What Is the Appropriate Price for Platelet-Rich Plasma Injections for Knee Osteoarthritis? A Cost-Effectiveness Analysis Based on Evidence From Level I Randomized Controlled Trials.

Here are the key passages from the abstract about the price tag that would make PRP potentially “worth” the cost:

“RESULTS:

Nine randomized controlled trials met the inclusion criteria. A total of 882 patients were included: 483 in the PRP group, 338 in the HA group, and 61 in the saline solution group. Baseline mean utility scores ranged from 0.55 to 0.57 for the PRP, HA, and saline solution groups. The 6-month gains in utility were 0.12, 0.02, and -0.06, respectively. The 12-month gains in utility from before injection were 0.14, 0.03, and 0.06, respectively. The lowest total costs for HA and saline solution were $681.93 and $516.29, respectively. For PRP to be cost-effective, the total treatment cost would have to be less than $3,703.03 and $1,192.08 for 6- and 12-month outcomes, respectively.

CONCLUSIONS:

For patients with symptomatic knee osteoarthritis, PRP is cost-effective, from the payer perspective, at a total price (inclusive of clinic visits, the procedure, and the injectable) of less than $1,192.08 over a 12-month period, relative to HA and saline solution.”

I also found a great YouTube video of a lecture by Dr. Landsdown about PRP that also bears on efficacy and cost as well, which I’ve posted below. I recommend watching the whole thing as he’s a really good speaker with a focus on data.

How about “exosome therapy” cost?

The cost of marketed exosome therapy in the polling also is based on fewer responses than stem cell therapy polling, but the few responses suggest the cost falls somewhere in the middle between stem cell injections and PRP.

While no exosome products have been approved by the FDA, they have still been marketed for several years for a variety of conditions. Exosomes most recently made news as they were being marketed for COVID-19, sparking an FDA letter.

I would have predicted that those firms marketing exosome injections would peg the price tag to be somewhat lower than stem cell injections and that seems to be the case. No one in the poll said they paid more than $10,000 for exosomes. Most people paid between $2,000 and $7,500.

Have prices changed? Comparing to 2019 Polling

How much is stem cell therapy? Polls

For comparison, the 2019 polling can be found here, but some of the key results are captured in a combo screenshot I’ve included here. I got a lot more responses to the polling in 2019 so that makes me more confident in the data than in the 2020 polling so far, but I hope we’ll get more responses moving forward in 2020 and if we do, again I’ll update the info in this post.

What you can see from 2019 is that a plurality of respondents reported getting one stem cell injection, but 60% of people nonetheless got more than one stem cell injection.

Remarkably about 1 in 20-25 people received more than 20 stem cell injections.

About another 1 in 20 people got 6-20 injections. I find this amount of repeat injections to be surprising and concerning as it amplifies health and financial risks.

In terms of cost per injection, the results are pretty similar to 2018 (see at right below) on the whole.

This kind of polling isn’t super scientific, but can gauge trends. Unfortunately, I haven’t really seen much other published data on stem cell clinic costs in actual journals.

I don’t know if it’s noise or not, but the percentage of people paying over $100K is about 2-fold higher in 2019 versus 2018.

There are more people may be paying $10K-$20K as well now in 2020 vs. 2019 or 2018.

Stem Cells Cost: supplements

There is growing interest from the public in stem cell supplements. I did a post on this earlier in 2020 so take a look here, which was essentially a review of stem cell supplements. In terms of cost, while supplements are far less expensive than getting stem cell, PRP, or exosome injections, supplements are still pricey for what you get. It’s not unusual to pay $100 for a small bottle of stem cell supplements, the other factor to consider is that these supplements generally have no solid, published data behind them so you might as well be paying $100 for water. It’s unclear what risks taking these supplements might bring as well.

FTC actions and patients as consumers

On the economic side, you might think that the feds like the FTC would be actively pursuing false or even fraudulent marketing of stem cells via the web and other kinds of advertising, but in total so far the FTC to my knowledge has only taken relatively few actions such as this one last year. and then some letters for COVID-related marketing of stem cells and other biologics earlier this year in 2020.

Oddly, there were just that a couple blips of FTC activity, especially considering the sea of questionable stem cell clinic-related ads out there. This ranges from major newspapers to inflight magazines to mobile ads on a stem-cell-mobile to television. Then of course there are the infomercial seminars.

Patients should also view themselves as consumers. Savvy customers considering paying money to stem cell clinics should do their homework. I often tell patients to use at a minimum the kinds of tough standards they bring to the car-buying process. Over the last few years Consumer Reports has been interested in the stem cell treatment world and done some reporting that is worth reading.

Does insurance cover the cost of stem cell treatments?

Unfortunately for patients desperate to try stem cells, insurance generally does not provide any coverage, which often leads them to take extreme financial measures. These steps can include fundraising (more below).

In  my view, the Regenexx brand has made a big deal out of how some employers contribute towards costs of their clinics’ offerings, but I’m not so clear on where that stands today in 2020. Here’s a key passage from my past post on stem cell insurance coverage:

“From what I’ve seen, Regenexx seems to be the main provider of stem cell injections that has gotten some limited coverage okayed, mainly through certain employers. While Regenexx seems compliant with FDA regulations here in the U.S., in my opinion there aren’t rigorous data to prove it works. This new paper for knee arthritis with Regenexx is worth a closer look as it seems at least relatively stronger in design than past studies in this arena even if it wasn’t blinded/lacked placebo control and wasn’t a large study.

Overall, I haven’t seen other stem cell clinics get any kind of real insurance or corporate coverage, although perhaps there are a few buried amongst the ~1000 clinics out there these days. Medicare also does not cover stem cell injections.”

Patient fundraising: ethics and effect on net stem cells cost

Patients are often reaching out to me so I know that many of them have gone to extraordinary measures to raise the money to pay to unproven stem cell clinics. It’s painful to think about what little they get in return. Since we are by definition talking about unproven medical procedures here, in my view this money is largely down the drain.

If you have other data on stem cell economic issues such as what patients pay please let me know. Then there’s the issue of what it actually costs the clinics per injection and in turn: what’s their profit margin?

What ends up happening is that patients take out second mortgages on their houses, try to collect funds from friends and relatives, or turn to online fundraising. The internet fundraising efforts most often end up on GoFundMe. This is a trend I’ve been noticing for years. Some colleagues even published a paper on this trend, a very interesting and an important read. The paper is “Crowdfunding for Unproven Stem Cell–Based Interventions” in JAMA by Jeremy Snyder, Leigh Turner , and Valorie A. Crooks. Here’s a key passage:

“As of December 3, 2017, our search identified 408 campaigns (GoFundMe = 358; YouCaring = 50) seeking donations for stem cell interventions advertised by 50 individual businesses. These campaigns requested $7 439 308 and received pledges for $1 450 011 from 13 050 donors. The campaigns were shared 111 044 times on social media. Two campaigns were duplicated across platforms but shared separately on social media. Of the 408 campaigns, 178 (43.6%) made statements that were definitive or certain about the intervention’s efficacy, 124 (30.4%) made statements optimistic or hopeful about efficacy, 63 (15.4%) made statements of both kinds, and 43 (10.5%) did not make efficacy claims. All mentions of risks (n = 36) claimed the intervention had low/no risks compared with alternative treatments.”

Supposedly GoFundMe has taken some steps to lower the often ethically thorny stem cell fundraising on its site, but I’m not sure how much it has changed.

Looking ahead, will stem cell costs go down?

There is pressure on stem cell clinics now in 2020 in large part due to two factors, which could drive costs down or up depending on how things play out. First, the FDA is much more active against unproven stem cell clinics. This may mean more money from the clinics going toward paying attorneys and/or FDA compliance experts. You’d think this might drive costs up, but the still large number of clinics may keep pressure to stay with keeping price tags lower.

The second factor in 2020 is the COVID-19 pandemic, which has forced many clinics to stop injections temporarily. While a surprising number of clinicsI did by phone were still open in a small informal survey, others were in a holding pattern. This may lower supply which could raise prices, but I think demand is likely way down as many patients stay home to avoid COVID risks. This could be temporary though and as things start re-opening, as they are now, the clinics may be able to capitalize on a surge of pent-up demand.

To sum up, the answer to the question, “How do stem cells cost?” is largely driven by clinic firms aiming to profit. Overall, clinics will charge what they think patients will pay them, which will always be a moving target. I urge patients to be cautious both medically, talking to their doctors, and financially.

Some notes:

  1. This post focuses on offerings of stem cells and other regenerative services such as PRP and exosomes. It is not focused on the costs associated with proven bone marrow or hematopoietic stem cell transplants for blood cancers. These costs can also be high, but are generally covered by insurance and scientifically proven in most cases. In that same sphere, bone marrow or hematopoietic stem cell transplants for autoimmune disorders such as multiple sclerosis (MS), scleroderma, and others are often not covered by insurance as they are still considered experimental. However, that might be changing as more data accumulates that immune ablation followed by hematopoietic stem cell transplants is quite effective for some patients. More data needs to be published in this area. I’ve had past concerns about patients being charged for these still investigational hematopoietic stem cell transplants for autoimmune disorders including at Northwestern. You can read about that here.
  2. It’s very important to factor in the number of injections that patients are receiving. If the cost per injection is, for example, $5,000 then the total cost goes up to $20K if the patient gets 4 injections on average from the clinic. Many clinics offer discounts on subsequent stem cell injections after the first one. The same seems to be true for PRP and exosomes.
  3. Clinics may also increasingly have to pay more for malpractice insurance as the number of patient lawsuits goes up. They are likely to pass these costs, or at least try to, on to patients.
  4. This post is not meant as medical or financial advice.
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