title: Assessing the charges associated with hematopoietic stem cell mobilization and remobilization in patients with lymphoma and multiple myeloma undergoing autologous hematopoietic peripheral blood stem cell transplantation.
abstract: BACKGROUND
  The purpose of this study was to perform a detailed analysis of the charges associated with chemomobilization and remobilization of autologous hematopoietic stem cells (HSCs) and to quantify medical costs and resource utilization associated with these procedures.
  
  
  METHODS
  Patients with lymphoma underwent chemomobilization with ifosfamide and etoposide with or without rituximab (IE ± R). Patients with multiple myeloma (MM) received a modified hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone (hyper-CVAD) regimen after failing to mobilize with growth factors only.
  
  
  RESULTS
  Between January 2004 and October 2006, 98 patients with lymphoma underwent HSC mobilization with IE ± R. Mobilization with IE ± R was effective, with 90.8% of patients collecting at least 2 × 10(6) CD34+ cells/kg. The total charges for treatment were $27,996 and $37,667 for patients mobilized with IE and IE + R, respectively. Hospital readmission for complications occurred in 26.5% of patients, resulting in additional charges of $10,356. The preapheresis procedure charge was estimated to be $2522, the charge for a 2-day apheresis session was $5160, and the postapheresis phase resulted in charges of $8040. Our analysis determined that reducing apheresis by 1 day has the potential to save $6600. We also performed a retrospective analysis of 16 patients with MM remobilized with a modified hyper-CVAD regimen. Remobilization was successful, with 87.5% of patients. Our analysis determined that mobilization, preapheresis, apheresis, and postapheresis phase charges were $24,968, $2522, $6158, and $12,060, respectively.
  
  
  CONCLUSIONS
  Optimization of HSC mobilization regimens to reduce failure rates would not only benefit patients but also reduce the overall medical costs.
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston, Texas 77030, USA. cmhosing@mdanderson.org
authors.forename: Chitra
authors.initials: C
authors.lastname: Hosing
authors.forename: Veronica
authors.initials: V
authors.lastname: Smith
authors.forename: Beverly
authors.initials: B
authors.lastname: Rhodes
authors.forename: Kent
authors.initials: K
authors.lastname: Walters
authors.forename: Richmond
authors.initials: R
authors.lastname: Thompson
authors.forename: Muzaffar
authors.initials: M
authors.lastname: Qazilbash
authors.forename: Issa
authors.initials: I
authors.lastname: Khouri
authors.forename: Marcos
authors.initials: M
authors.lastname: de Lima
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Balzer
authors.forename: John
authors.initials: J
authors.lastname: McMannis
authors.forename: Richard
authors.initials: R
authors.lastname: Champlin
authors.forename: Sergio
authors.initials: S
authors.lastname: Giralt
authors.forename: Uday
authors.initials: U
authors.lastname: Popat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005047:Etoposide / Q000627:therapeutic use; D005260:Female; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods*; D006801:Humans; D007069:Ifosfamide / Q000627:therapeutic use; D008223:Lymphoma / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000628:therapy*; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods*; D000069283:Rituximab; D014182:Transplantation, Autologous / Q000379:methods*; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab; D005047:Etoposide; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide; D007069:Ifosfamide