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

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

Research output: Contribution to journalArticle

51 Citations (Scopus)

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 2013

Fingerprint

Hematopoietic Stem Cell Mobilization
Cost-Benefit Analysis
Blood Component Removal
Granulocyte Colony-Stimulating Factor
Costs and Cost Analysis
JM 3100
Peripheral Blood Stem Cells
Stem Cell Transplantation

Keywords

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

ASJC Scopus subject areas

  • Transplantation
  • Hematology

Cite this

Cost-Effectiveness Analysis of a Risk-Adapted Algorithm of Plerixafor Use for Autologous Peripheral Blood Stem Cell Mobilization. / Micallef, Ivana; Sinha, Shirshendu; Gastineau, Dennis A.; Wolf, Robert; Inwards, David J.; Gertz, Morie; Hayman, Suzanne R.; Hogan, William; Johnston, Patrick Bruce; Lacy, Martha; Ansell, Stephen Maxted; Buadi, Francis; Dingli, David M; Dispenzieri, Angela; Litzow, Mark R; Porrata, Luis F.; Winters, Jeffrey L.; Kumar, Shaji K.

In: Biology of Blood and Marrow Transplantation, Vol. 19, No. 1, 01.2013, p. 87-93.

Research output: Contribution to journalArticle

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AU - Hayman, Suzanne R.

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N2 - 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.

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