title: Cost-effectiveness analysis of a risk-adapted algorithm of plerixafor use for autologous peripheral blood stem cell mobilization.
abstract: Historically, up to 30% of patients were unable to collect adequate numbers of peripheral blood stem cells (PBSCs) for autologous stem cell transplantation (ASCT). Plerixafor in combination with granulocyte colony-stimulating factor (G-CSF) has shown superior results in mobilizing peripheral blood (PB) CD34+ cells in comparison to G-CSF alone, but its high cost limits general use. We developed and evaluated risk-adapted algorithms for optimal utilization of plerixafor. In plerixafor-1, PBSC mobilization was commenced with G-CSF alone, and if PB CD34 on day 4 or day 5 was <10/μL, plerixafor was administered in the evening, and apheresis commenced the next day. In addition, if on any day, the daily yield was <0.5 × 10(6) CD34/kg, plerixafor was added. Subsequently, the algorithm was revised (plerixafor-2) with lower thresholds. If day-4 PB CD34 <10/μL for single or <20/μL for multiple transplantations, or day-1 yield was <1.5 × 10(6) CD34/kg, or any subsequent daily yield was <0.5 × 10(6) CD34/kg, plerixafor was added. Three time periods were analyzed for results and associated costs: January to December 2008 (baseline cohort; 319 mobilization attempts in 278 patients); February to November 2009 (plerixafor-1; 221 mobilization attempts in 216 patients); and December 2009 to June 2010 (plerixafor-2; 100 mobilization attempts in 98 patients). Plerixafor-2 shows a significant improvement in PB CD34 collection, increased number of patients reaching minimum and optimal goals, fewer days of apheresis, and fewer days of mobilization/collection, albeit at increased costs. In conclusion, although the earlier identification of ineffective PBSC mobilization and initiation of plerixafor (plerixafor-2) increases the per-patient costs of PBSC mobilization, failure rates, days of apheresis, and total days of mobilization/collection are lower.
authors.affiliation: Division of Hematology/Blood & Marrow Transplantation, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. micallef.ivana@mayo.edu
authors.forename: Ivana N M
authors.initials: IN
authors.lastname: Micallef
authors.forename: Shirshendu
authors.initials: S
authors.lastname: Sinha
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Gastineau
authors.forename: Robert
authors.initials: R
authors.lastname: Wolf
authors.forename: David J
authors.initials: DJ
authors.lastname: Inwards
authors.forename: Morie A
authors.initials: MA
authors.lastname: Gertz
authors.forename: Suzanne R
authors.initials: SR
authors.lastname: Hayman
authors.forename: William J
authors.initials: WJ
authors.lastname: Hogan
authors.forename: Patrick B
authors.initials: PB
authors.lastname: Johnston
authors.forename: Martha Q
authors.initials: MQ
authors.lastname: Lacy
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Ansell
authors.forename: Francis
authors.initials: F
authors.lastname: Buadi
authors.forename: David
authors.initials: D
authors.lastname: Dingli
authors.forename: Angela
authors.initials: A
authors.lastname: Dispenzieri
authors.forename: Mark R
authors.initials: MR
authors.lastname: Litzow
authors.forename: Luis F
authors.initials: LF
authors.lastname: Porrata
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Winters
authors.forename: Shaji
authors.initials: S
authors.lastname: Kumar
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001596:Benzylamines; D016022:Case-Control Studies; D003365:Costs and Cost Analysis; D000080027:Cyclams; D005260:Female; D019650:Hematopoietic Stem Cell Mobilization / Q000191:economics* / Q000379:methods; D006571:Heterocyclic Compounds / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics*; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000191:economics / Q000628:therapy; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000191:economics*; D010954:Plasmacytoma / Q000191:economics / Q000628:therapy; D012307:Risk Factors; D013997:Time Factors; D014182:Transplantation, Autologous
chemical_list: D001596:Benzylamines; D000080027:Cyclams; D006571:Heterocyclic Compounds; C088327:plerixafor