title: Cost analysis of a randomized stem cell mobilization study in multiple myeloma.
abstract: Upfront autologous stem cell transplantation (ASCT) is the standard therapy for younger multiple myeloma (MM) patients. MM patients usually undergo stem cell mobilization with cyclophosphamide (CY) followed by granulocyte colony-stimulating factor (G-CSF), or with G-CSF alone. A limited number of randomized studies are available comparing costs of different mobilization strategies. Eighty transplant-eligible patients aged up to 70 years with untreated MM were included in this prospective study. The patients were treated with RVD induction for three 21-day cycles and randomized 1:1 at inclusion into one of the two mobilization arms CY 2 g/m(2) + G-CSF [arm A] vs. G-CSF alone [arm B]. Plerixafor was given according to a specific algorithm if needed. Sixty-nine patients who received mobilization followed by blood graft collection were included in the cost analysis. The median total costs of the mobilization phase were significantly higher in arm A than in arm B (3855 € vs. 772 €, p ≤ 0.001). The cumulative median cost of the mobilization and collection phases was significantly lower in arm B than in arm A (8524 € vs. 11,622 €, p = 0.012). There was no significant difference between the arms in the total median costs of ASCT (n = 59) (34,997 € in arm A vs. 31,981 € in arm B, p = 0.118). Mobilization with G-CSF alone seems to be a preferable mobilization method for MM patients in terms of mobilization and apheresis costs. In addition, it requires less hospital resource utilization.
authors.affiliation: Department of Medicine, Kuopio University Hospital, Kuopio, Finland. ville.varmavuo@iki.fi.|Department of Medicine, Kymenlaakso Central Hospital, Kotkantie 41, 48210, Kotka, Finland. ville.varmavuo@iki.fi.
authors.forename: Ville
authors.identifier: http://orcid.org/0000-0001-5070-6018
authors.initials: V
authors.lastname: Varmavuo
authors.affiliation: Department of Medicine, Kuopio University Hospital, Kuopio, Finland.|Division of Hematology, Comprehensive Cancer Center, Helsinki University and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Raija
authors.initials: R
authors.lastname: Silvennoinen
authors.affiliation: Division of Hematology, Comprehensive Cancer Center, Helsinki University and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Pekka
authors.initials: P
authors.lastname: Anttila
authors.affiliation: Department of Medicine, Oulu University Hospital, Oulu, Finland.
authors.forename: Marjaana
authors.initials: M
authors.lastname: Säily
authors.affiliation: Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.
authors.forename: Marja
authors.initials: M
authors.lastname: Sankelo
authors.affiliation: Department of Medicine, Turku University Hospital, Turku, Finland.
authors.forename: Mervi
authors.initials: M
authors.lastname: Putkonen
authors.affiliation: Hospital Pharmacy of Kuopio University Hospital, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Jouni
authors.initials: J
authors.lastname: Ahonen
authors.affiliation: Laboratory of Eastern Finland, Kuopio, Finland.
authors.forename: Eija
authors.initials: E
authors.lastname: Mahlamäki
authors.affiliation: Laboratory of Eastern Finland, Kuopio, Finland.
authors.forename: Pentti
authors.initials: P
authors.lastname: Mäntymaa
authors.affiliation: Nordlab Oulu, Medical Research Center, Oulu University Hospital, Oulu, Finland.
authors.forename: Eeva-Riitta
authors.initials: ER
authors.lastname: Savolainen
authors.affiliation: Department of Medicine, Turku University Hospital, Turku, Finland.|University of Turku, Turku, Finland.
authors.forename: Kari
authors.initials: K
authors.lastname: Remes
authors.affiliation: Department of Medicine, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Esa
authors.initials: E
authors.lastname: Jantunen
mesh_terms: D000328:Adult; D000368:Aged; D001596:Benzylamines; D001772:Blood Cell Count; D001781:Blood Component Removal / Q000191:economics; D001853:Bone Marrow / Q000187:drug effects; D003131:Combined Modality Therapy; D003365:Costs and Cost Analysis; D000080027:Cyclams; D003520:Cyclophosphamide / Q000494:pharmacology; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000494:pharmacology; D019650:Hematopoietic Stem Cell Mobilization / Q000191:economics*; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics*; D006571:Heterocyclic Compounds / Q000494:pharmacology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000191:economics* / Q000628:therapy; D011446:Prospective Studies
chemical_list: D001596:Benzylamines; D000080027:Cyclams; D006571:Heterocyclic Compounds; D016179:Granulocyte Colony-Stimulating Factor; D003520:Cyclophosphamide; C088327:plerixafor
keywords: Autologous stem cell transplantation; Cost analysis; Cyclophosphamide; Multiple myeloma; Plerixafor; Stem cell mobilization