title: Mobilization, collection, and processing of autologous peripheral blood stem cells: development of a clinical process with associated costs.
abstract: We surveyed five academic medical centers to develop a clinical process for patients undergoing cytokine mobilization and leukapheresis prior to autologous peripheral blood stem cell transplantation. Costs were obtained from three centers and applied to each component of the pathway. Costs were divided into three categories: (1) pre-apheresis evaluation; (2) process of apheresis; (3) post-apheresis and peripheral blood stem cells processing. All centers participated in the development of the leukapheresis pathway. Because charges vary greatly among institutions, costs were determined from three of the institutions and a mean was calculated for each of the components of the process. Pre-apheresis costs consisted of central line placement, blood work, and the price of cytokine (rhG-CSF). Costs associated with apheresis included professional fees (for physicians and nurses), leukapheresis with stem cell cryopreservation, storage, sterility testing, analysis of circulating CD34+ cell counts, and 1 day of cytokine therapy. The post-apheresis process included thawing with sterility testing along with CD34+ cell number analysis and the performance of clonogenic assays. Total costs were as follows: (1) pre-apheresis, $2711; (2) apheresis, $2990; and, (3) post-apheresis/stem cell processing, $754. This survey from five academic medical centers provides the average costs associated with three main components of the apheresis procedure. Because many patients require multiple aphereses, interventions to achieve target CD34+ cell collections in as few collections as possible would result in significant cost reduction.
authors.affiliation: Division of Hematology and Oncology, Georgetown University Medical Center, Washington, DC 20007, USA. Meehankr@gunet.georgetown.edu
authors.forename: K R
authors.initials: KR
authors.lastname: Meehan
authors.forename: E M
authors.initials: EM
authors.lastname: Areman
authors.forename: S G
authors.initials: SG
authors.lastname: Ericson
authors.forename: C
authors.initials: C
authors.lastname: Matias
authors.forename: R
authors.initials: R
authors.lastname: Seifeldin
authors.forename: K
authors.initials: K
authors.lastname: Schulman
mesh_terms: D003114:Colony-Forming Units Assay; D003365:Costs and Cost Analysis; D016207:Cytokines / Q000191:economics / Q000627:therapeutic use; D019650:Hematopoietic Stem Cell Mobilization / Q000191:economics / Q000379:methods*; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics / Q000379:methods*; D006412:Hematopoietic Stem Cells / Q000166:cytology*; D006801:Humans; D007937:Leukapheresis / Q000191:economics / Q000379:methods; D014021:Tissue Preservation / Q000191:economics / Q000379:methods; D014182:Transplantation, Autologous; D014481:United States
chemical_list: D016207:Cytokines