Economic analysis of a randomized clinical trial to compare filgrastim-mobilized peripheral-blood progenitor-cell transplantation and autologous bone marrow transplantation in patients with Hodgkin's and non-Hodgkin's lymphoma.

Abstract

PBPCT is as safe and more effective than ABMT for HD and NHL in the short term. PBPCT represents a significant cost savings due to lower autograft collection costs, shorter hospital stays, and less supportive care. The savings exceed the costs for filgrastim mobilization and PBPC collection. Actual savings will vary depending on local practice patterns, charges, and costs.

Reduced charges and costs associated with outpatient autologous stem cell transplantation

“…Even with the use of hematopoietic growth factors and mobilized blood progenitor cells, which have shortened neutropenia and allowed earlier hospital discharge, hospital stays of 16 to more than 30 days are typical. 2,3,4 Peters and colleagues, 5 at Duke University Medical Center, pioneered a structured outpatient bone marrow transplant program wherein patients received all their highdose chemotherapy as inpatients and then were discharged to a 7-day-a-week outpatient clinic located a short distance from the main hospital. These patients had stage 2-4 breast cancer and received a high-dose chemotherapy regimen which did not induce a significant rate of mucositis, esophagitis or enteritis.…”

“…Each day's chemotherapy was infused over 4 h. Previously mobilized and cryopreserved peripheral blood progenitor cells were infused 48 h after the completion of chemotherapy. Granulocyte colony-stimulating factor (G-CSF) 5 g/kg was administered subcutaneously beginning on the day of peripheral blood progenitor cell reinfusion and continued until the absolute neutrophil count was Ͼ2000 mm 3 .…”

Prospective economic evaluation accompanying a trial of GM-CSF/IL-3 in patients undergoing autologous bone marrow transplantation for Hodgkin’s and non-Hodgkin’s lymphoma

“…We observed the cost of a transplant hospitalization to be between $69 002 and $79 884 (not including the cost of cytokine therapy). Smith et al 10 found an average cost of $59 314 for the hospitalization for ABMT in a study of patients with Hodgkin's and non-Hodgkin's lymphoma. However, resource utilization for this study was based on patients treated in Europe, with costs for these resources developed at one clinical center in the United States.…”

“…To the extent that bone marrow transplantation is a resource-intensive procedure in all countries, resource utilization data can be generalized to other countries. 10 Since costs differ between countries for these resources as received by patients, the data on total costs may not be as general as the resource data. Economic evaluation is most interested, however, in the incremental costs of a new treatment compared to the existing standard of care.…”

“…Prospective economic assessment of new cancer treatments during the clinical development process is a relatively recent development. [5][6][7][8][9][10] This assessment measures the costs of treatment for patients, compares these costs to the clinical benefits received by patients, 5 and offers the potential for improved decision making regarding adoption of new medical technologies in an increasingly constrained health care system.…”