title: An economic evaluation of peripheral blood stem cell transplantation as an alternative to autologous bone marrow transplantation in multiple myeloma.
abstract: Autologous peripheral blood stem cell transplantation (PBSCT) is increasingly being utilised as an alternative to autologous bone marrow transplantation (ABMT) in the treatment of malignant diseases. We have performed a pharmacoeconomic study using cost-minimisation analysis to evaluate the two techniques in a population of multiple myeloma patients undergoing PBSCT (n = 37) or ABMT (n = 14). In the PBSCT group, the time to > 0.5 x 10(9)/l neutrophils was significantly shorter (16 vs 22 days; P = 0.0019) as was the time to > 50 x 10(9)/l platelets (19 vs 27 days; P = 0.0019). The faster haematopoietic recovery resulted in a reduced period of intravenous antibiotic therapy (12 vs 19 days; P < 0.0001), reduced requirements for platelet transfusions (12 vs 31.5 units; P = 0.0005), and ultimately, a significant reduction in duration of hospitalisation (19 vs 27.5 days; P < 0.0001). These clinical benefits translated into economic benefits such that the total cost in the PBSCT group was 27.5% less than in the ABMT group (< Pounds 7995 vs < Pounds 11026; P = 0.0001). We conclude that the use of PBSCT as an alternative to ABMT in patients with multiple myeloma is associated with demonstrable economic advantages in addition to clinical benefits.
authors.affiliation: Pharmacy Department, Royal Marsden NHS Trust, Sutton, Surrey, UK.
authors.forename: N
authors.initials: N
authors.lastname: Duncan
authors.forename: M
authors.initials: M
authors.lastname: Hewetson
authors.forename: R
authors.initials: R
authors.lastname: Powles
authors.forename: N
authors.initials: N
authors.lastname: Raje
authors.forename: J
authors.initials: J
authors.lastname: Mehta
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D001855:Bone Marrow Diseases / Q000139:chemically induced / Q000628:therapy; D016026:Bone Marrow Transplantation / Q000191:economics*; D003289:Convalescence; D004363:Drug Utilization; D005260:Female; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000191:economics / Q000494:pharmacology; D006410:Hematopoiesis / Q000187:drug effects; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics*; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D007937:Leukapheresis / Q000191:economics; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000191:economics / Q000628:therapy*; D010289:Parenteral Nutrition, Total / Q000191:economics; D017713:Platelet Transfusion / Q000191:economics / Q000706:statistics & numerical data; D011994:Recombinant Proteins; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D000069585:Filgrastim