A transition from using multi‐step procedures to a fully integrated system for performing extracorporeal photopheresis: A comparison of costs and efficiencies

Abstract

IntroductionThe Pitié Salpêtrière Hospital Hemobiotherapy Department, Paris, France, has been providing extracorporeal photopheresis (ECP) since November 2011, and started using the Therakos® CELLEX® fully integrated system in 2012. This report summarizes our single‐center experience of transitioning from the use of multi‐step ECP procedures to the fully integrated ECP system, considering the capacity and cost implications.Materials and MethodsThe total number of ECP procedures performed 2011–2015 was derived from department records. The time taken to complete a single ECP treatment using a multi‐step technique and the fully integrated system at our department was assessed. Resource costs (2014€) were obtained for materials and calculated for personnel time required. Time‐driven activity‐based costing methods were applied to provide a cost comparison.ResultsThe number of ECP treatments per year increased from 225 (2012) to 727 (2015). The single multi‐step procedure took 270 min compared to 120 min for the fully integrated system. The total calculated per‐session cost of performing ECP using the multi‐step procedure was greater than with the CELLEX® system (€1,429.37 and €1,264.70 per treatment, respectively).ConclusionsFor hospitals considering a transition from multi‐step procedures to fully integrated methods for ECP where cost may be a barrier, time‐driven activity‐based costing should be utilized to gain a more comprehensive understanding the full benefit that such a transition offers. The example from our department confirmed that there were not just cost and time savings, but that the time efficiencies gained with CELLEX® allow for more patient treatments per year.

“Best practice” for extracorporeal photopheresis in acute and chronic graft‐versus‐host disease by Societa’ Italiana di Emaferesi and Manipolazione Cellulare and Gruppo Italiano Trapianto Midollo Osseo: a national survey to ascertain its degree of application in Italian transplant centers

“…Moreover, a very recent update of the same UK consensus group confirmed these indications, indicating fair to good evidence to treat patients with skin, hepatic, and cardiac involvement and poor evidences to treat patients with gastrointestinal/pulmonary and renal involvement. A recent Italian retrospective analysis showed similar results with an overall response of 90% in unselected patients with acute GVHD treated by ECP as their second‐line therapy . With respect to the answer given by our best practice to Question 16, we must consider that most Italian centers use off‐line techniques (this survey reported at least 71% of centers using off‐line, and 54% use off‐line only) that, in harmony with other off‐line cell manipulations procedures, should be carried out respecting the requirements stated by several European directives on this specific field (e.g., European Directives 2004/23/CE, 2006/17/CE, 2006/86/CE).…”

“…The current availability of the Therakos Cellex Technology opens new opportunities to have an integrated system (avoiding any further complexity and extra costs related to the need of an accredited cell processing laboratory) that assures fast, safe, effective, and widely applicable procedures with competitive expenses. 5,6 With respect to the chance of starting a prospective study for GVHD prophylaxis, recent publications on small Phase II studies showed some encouraging results for ECP in combination with immunosuppresants. 7,8…”

Vascular access considerations for extracorporeal photopheresis

“…The ECP procedure consists of three sequential phases: collection of buffy coat, photoactivation with ultraviolet A (UV‐A) light, and reinfusion of treated cells. The procedure can be performed using a “closed” system that incorporates all three phases into one device or with an “open” system that consists of separate instrumentation for the leukapheresis and photoactivation phases …”

“…The 8‐MOP formulation is FDA approved and commercially known as UVADEX. 8‐MOP intercalates between DNA strands and forms weak bonds with cellular proteins . The photoactivation phase occurs when the buffy coat/8‐MOP suspension is irradiated.…”

“…The procedure can be performed using a "closed" system that incorporates all three phases into one device or with an "open" system that consists of separate instrumentation for the leukapheresis and photoactivation phases. 5,6 During the collection phase whole blood is centrifuged and separated into its components. White blood cells (WBCs) are collected into a treatment reservoir while plasma and red blood cells (RBCs) are returned to the patient.…”