title: [Cost of intensive treatment followed by autograft of circulating stem cells. Application to multiple myeloma].
abstract: OBJECTIVE
  Legitimate efforts to reduce health care costs, especially of intensive protocols including transplantation for haematological diseases, require realistic economic evaluations. We determined the direct cost of intensive chemotherapy associated with total body irradiation and autologous blood stem cell transplantation in patients with multiple myeloma.
  
  
  METHODS
  Ten consecutive patients (7 males, 3 females) with Stage II or II multiple myeloma, who had received no prior treatment and were under the age of 55, were included in the study. Peripheral blood stem cells were collected by successive cytaphereses after a short period of aplasia induced by a CHOP protocol. During this period, the patients were in normal hospital rooms. A VAMP protocol was then administered in three 4-day sessions. Intensive therapy was started 1 month later with CCNU, etoposide, cyclophosphamide and melphalan. Total body irradiation (12 Gy) was performed on days -3, -2, -1. Autologous grafting was done on day 0. The intensive therapy was followed by a period of aplasia and the patients were protected in laminar flow rooms. Regular antibiotic and haematologic protocols were applied. Growth hormone was not given. The patients were seen regularly for follow-up and interferon alpha 2b was prescribed for 5.
  
  
  RESULTS
  The mean cost of the two year treatment was 468,392 +/- 167,467 French francs. Personnel accounted for 36% of the total cost, marrow collection 13%, blood products 9.8%, laboratory tests 8.2% and drugs 7.2%. Little data are available in the literature of comparable cost analyses in other French hospitals or in other countries.
  
  
  CONCLUSIONS
  Controlled cost/benefit studies should be conducted to enable a rigorous comparison between different therapeutic strategies.
authors.affiliation: Service de Pharmacie, Hôpital Cochin, Paris.
authors.forename: S
authors.initials: S
authors.lastname: Callaert
authors.forename: P
authors.initials: P
authors.lastname: Ravaud
authors.forename: C
authors.initials: C
authors.lastname: Viens-Bitker
authors.forename: F
authors.initials: F
authors.lastname: Dreyfus
authors.forename: G
authors.initials: G
authors.lastname: Hazebroucq
authors.forename: B
authors.initials: B
authors.lastname: Amor
authors.forename: J C
authors.initials: JC
authors.lastname: Brouet
authors.forename: J P
authors.initials: JP
authors.lastname: Fermand
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003422:Critical Care; D016238:Cytapheresis / Q000191:economics* / Q000379:methods; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000191:economics* / Q000628:therapy; D012189:Retrospective Studies; D014182:Transplantation, Autologous
vernacular_title: Coût d'un traitement intensif suivi d'une autogreffe de cellules souches circulantes. Application au myélome multiple.