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.
OBJECTIVE
High-dose chemotherapy (HDC) with peripheral-blood progenitor cell (PBPC) and autologous bone marrow (ABM) transplant (T) has documented survival benefits for relapsed Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL). Treatment costs associated with HDC and its supportive care have restricted its use both on and off clinical trial. In a prospective randomized clinical trial, filgrastim-mobilized PBPCT resulted in faster recovery of bone marrow function, with less hospitalization and supportive care than ABMT. This study was undertaken to analyze the costs of the two strategies using prospectively collected data from a randomized clinical trial that compared filgrastim-mobilized PBPCT versus ABMT.


METHODS
Clinical results and resource utilization from a randomized clinical trial that compared filgrastim-mobilized PBPCT versus ABMT following carmustine, etoposide, cytarabine, and melphalan (BEAM) HDC for HD and NHL are presented. The trial was performed in six centers in Germany, the United Kingdom, and Belgium. Resource utilization data were used to project costs and Massay Cancer Center (MCC) in the United States incurred the cost of treating the cohort. Costs were projected to the United States, because the economic implications to United States centers are significant, costs of care vary markedly among countries but resource utilization on this trial did not, and a randomized trial is unlikely to be performed in the United States.


RESULTS
Fifty-eight patients with relapsed HD or NHL underwent HDC with BEAM. The PBPCT and ABMT groups had similar short-term survival after BEAM. PBPCT patients had a shorter hospitalization (median, 17 v 23 days; P = .002), neutrophil recovery (11 v 14 days; P = .005), platelet recovery to > or = 20 x 10(9)/L (16 v 23 days; P = .02), and days of platelet transfusions (6 v 10; P < .001). Estimated costs were $8,531 for ABM harvest and $5,760 for PBPC collection, including filgrastim mobilization. The total estimated average cost was $59,314 for each ABMT patient versus $45,792 for each PBPCT patient. Cost savings of $13,521 (23%) were due to shorter hospitalizations with less supportive care.


CONCLUSIONS
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.
Smith
T J
TJ
Virginia Commonwealth University, Massey Cancer Center, Richmond 23298-0037, USA. tsmith@gems.vcu.edu
Hillner
B E
BE
Schmitz
N
N
Linch
D C
DC
Dreger
P
P
Goldstone
A H
AH
Boogaerts
M A
MA
Ferrant
A
A
Link
H
H
Zander
A
A
Yanovich
S
S
Kitchin
R
R
Erder
M H
MH
D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000191:economics*; D002173:Cancer Care Facilities / Q000191:economics* / Q000706:statistics & numerical data; D003131:Combined Modality Therapy / Q000191:economics; D003365:Costs and Cost Analysis; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000191:economics* / Q000627:therapeutic use; D006295:Health Resources / Q000706:statistics & numerical data; D006302:Health Services Research / Q000379:methods; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics*; D006689:Hodgkin Disease / Q000628:therapy*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008228:Lymphoma, Non-Hodgkin / Q000628:therapy*; D008875:Middle Aged; D011446:Prospective Studies; D011994:Recombinant Proteins; D012680:Sensitivity and Specificity; D014768:Virginia
D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D000069585:Filgrastim