Journal of Clinical Oncology, Vol 15, 5-10, Copyright © 1997 by American Society of Clinical Oncology
Economic analysis of a randomized clinical trial to compare filgrastim- mobilized peripheral-blood progenitor-cell transplantation and autologous bone marrow transplantation in patients with Hodgkin's and non-Hodgkin's lymphoma
TJ Smith, BE Hillner, N Schmitz, DC Linch, P Dreger, AH Goldstone, MA Boogaerts, A Ferrant, H Link, A Zander, S Yanovich, R Kitchin and MH Erder
Virginia Commonwealth University, Massey Cancer Center, Richmond 23298- 0037, USA. tsmith@gems.vcu.edu
PURPOSE: High-dose chemotherapy (HDC) with peripheral-blood progenitor cell
(PBPC) and autologous bone marrow (ABM) transplant (T) has documented
survival benefits for relapsed Hodgkin's disease (HD) and non-Hodgkin's
lymphoma (NHL). Treatment costs associated with HDC and its supportive care
have restricted its use both on and off clinical trial. In a prospective
randomized clinical trial, filgrastim-mobilized PBPCT resulted in faster
recovery of bone marrow function, with less hospitalization and supportive
care than ABMT. This study was undertaken to analyze the costs of the two
strategies using prospectively collected data from a randomized clinical
trial that compared filgrastim-mobilized PBPCT versus ABMT. PATIENTS AND
METHODS: Clinical results and resource utilization from a randomized
clinical trial that compared filgrastim-mobilized PBPCT versus ABMT
following carmustine, etoposide, cytarabine, and melphalan (BEAM) HDC for
HD and NHL are presented. The trial was performed in six centers in
Germany, the United Kingdom, and Belgium. Resource utilization data were
used to project costs and Massay Cancer Center (MCC) in the United States
incurred the cost of treating the cohort. Costs were projected to the
United States, because the economic implications to United States centers
are significant, costs of care vary markedly among countries but resource
utilization on this trial did not, and a randomized trial is unlikely to be
performed in the United States. RESULTS: Fifty-eight patients with relapsed
HD or NHL underwent HDC with BEAM. The PBPCT and ABMT groups had similar
short-term survival after BEAM. PBPCT patients had a shorter
hospitalization (median, 17 v 23 days; P = .002), neutrophil recovery (11 v
14 days; P = .005), platelet recovery to > or = 20 x 10(9)/L (16 v 23
days; P = .02), and days of platelet transfusions (6 v 10; P < .001).
Estimated costs were $8,531 for ABM harvest and $5,760 for PBPC collection,
including filgrastim mobilization. The total estimated average cost was
$59,314 for each ABMT patient versus $45,792 for each PBPCT patient. Cost
savings of $13,521 (23%) were due to shorter hospitalizations with less
supportive care. CONCLUSION: PBPCT is as safe and more effective than ABMT
for HD and NHL in the short term. PBPCT represents a significant cost
savings due to lower autograft collection costs, shorter hospital stays,
and less supportive care. The savings exceed the costs for filgrastim
mobilization and PBPC collection. Actual savings will vary depending on
local practice patterns, charges, and costs.
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32(4):
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|
|
|
|
|
|
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|
|
|
|
|
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|
|
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|
|
|
|
|
|
|
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17(9):
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|
|
|
|
|
|
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872(1):
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|
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|
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17(4):
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1998(24):
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