title: Impact of pharmacy practices on the cost of colony-stimulating factor use in pediatric stem cell transplantation: an institution-based analysis.
abstract: OBJECTIVE
  An evaluation of colony-stimulating factor (CSF) use in pediatric stem cell transplantation (SCT) was conducted to identify potential cost-efficiencies while preserving institutional standards of patient care.
  
  
  METHODS
  Clinical and pharmacy records of the 55 SCTs performed during fiscal year 1995 were reviewed. Material costs per vial and per microgram, exclusive of preparation or overhead costs, were used. The best costing strategy was defined as the least expensive stocking and dispensing practice to deliver the drug actually used during the study period.
  
  
  RESULTS
  CSFs were used in 35 of 55 transplants; 68% of usage was protocol-mandated to enhance engraftment; the remainder was associated with life-threatening complications of SCT. All use was consistent with published evidence-based guidelines. Changes in stocking and dispensing practices would result in an overall annual savings of $48,162 (fiscal year 1995 dollars), a 39% decrease in cost without a change in clinical application.
  
  
  CONCLUSIONS
  Our analysis demonstrates that stocking and dispensing practices place significant fiscal burden in the care of pediatric-aged patients and must be carefully considered. This analysis presents a model for evaluating all components of drug cost from a global perspective, highlighting a need for examination of pharmacy and manufacturing as well as clinical practices.
authors.affiliation: Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts 02115, USA. parsons@a1.tch.harvard.edu
authors.forename: S K
authors.initials: SK
authors.lastname: Parsons
authors.forename: K J
authors.initials: KJ
authors.lastname: Levine
authors.forename: L E
authors.initials: LE
authors.lastname: Hoorntje
authors.forename: W J
authors.initials: WJ
authors.lastname: Eichelberger
authors.forename: D K
authors.initials: DK
authors.lastname: Mayer
authors.forename: E C
authors.initials: EC
authors.lastname: Guinan
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D004304:Dosage Forms; D019317:Evidence-Based Medicine; D016179:Granulocyte Colony-Stimulating Factor / Q000191:economics*; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000191:economics*; D017408:Guidelines as Topic; D019650:Hematopoietic Stem Cell Mobilization / Q000191:economics*; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics; D006801:Humans; D007223:Infant; D010593:Pharmaceutical Services / Q000191:economics; D011994:Recombinant Proteins; D011996:Records; D014481:United States
chemical_list: D004304:Dosage Forms; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D016178:Granulocyte-Macrophage Colony-Stimulating Factor