Cost-Effectiveness Analysis of a Risk-Adapted Algorithm of Plerixafor Use for Autologous Peripheral Blood Stem Cell Mobilization

Ivana N.M. Micallef, Shirshendu Sinha, Dennis A. Gastineau, Robert Wolf, David J. Inwards, Morie A. Gertz, Suzanne R. Hayman, William J. Hogan, Patrick B. Johnston, Martha Q. Lacy, Stephen M. Ansell, Francis Buadi, David Dingli, Angela Dispenzieri, Mark R. Litzow, Luis F. Porrata, Jeffrey L. Winters, Shaji Kumar

Research output: Contribution to journalArticle

59 Scopus citations

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 × 106 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 × 106 CD34/kg, or any subsequent daily yield was <0.5 × 106 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.

Original languageEnglish (US)
Pages (from-to)87-93
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume19
Issue number1
DOIs
StatePublished - Jan 1 2013

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Keywords

  • Cost effective analysis
  • Plerixafor
  • Risk-adapted algorithm
  • Stem cell mobilization

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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