Department of Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston, Texas 77030, USA.
Transfusion. 2011 Jun;51(6):1300-13. doi: 10.1111/j.1537-2995.2011.03176.x. Epub 2011 May 16.
The purpose of this study was to perform a detailed analysis of the charges associated with chemomobilization and remobilization of autologous hematopoietic stem cells (HSCs) and to quantify medical costs and resource utilization associated with these procedures.
Patients with lymphoma underwent chemomobilization with ifosfamide and etoposide with or without rituximab (IE ± R). Patients with multiple myeloma (MM) received a modified hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone (hyper-CVAD) regimen after failing to mobilize with growth factors only.
Between January 2004 and October 2006, 98 patients with lymphoma underwent HSC mobilization with IE ± R. Mobilization with IE ± R was effective, with 90.8% of patients collecting at least 2 × 10(6) CD34+ cells/kg. The total charges for treatment were $27,996 and $37,667 for patients mobilized with IE and IE + R, respectively. Hospital readmission for complications occurred in 26.5% of patients, resulting in additional charges of $10,356. The preapheresis procedure charge was estimated to be $2522, the charge for a 2-day apheresis session was $5160, and the postapheresis phase resulted in charges of $8040. Our analysis determined that reducing apheresis by 1 day has the potential to save $6600. We also performed a retrospective analysis of 16 patients with MM remobilized with a modified hyper-CVAD regimen. Remobilization was successful, with 87.5% of patients. Our analysis determined that mobilization, preapheresis, apheresis, and postapheresis phase charges were $24,968, $2522, $6158, and $12,060, respectively.
Optimization of HSC mobilization regimens to reduce failure rates would not only benefit patients but also reduce the overall medical costs.
本研究旨在对自体造血干细胞（HSCs）动员和再动员相关费用进行详细分析，并量化与这些程序相关的医疗成本和资源利用。
淋巴瘤患者接受异环磷酰胺和依托泊苷联合或不联合利妥昔单抗（IE ± R）进行化学动员。多发性骨髓瘤（MM）患者在仅使用生长因子无法动员时接受改良的高剂量环磷酰胺、长春新碱、多柔比星、地塞米松（hyper-CVAD）方案治疗。
2004 年 1 月至 2006 年 10 月，98 例淋巴瘤患者接受 IE ± R 进行 HSC 动员。IE ± R 动员有效，90.8%的患者至少收集 2 × 10(6)个 CD34+细胞/kg。IE 动员和 IE + R 动员的治疗总费用分别为 27996 美元和 37667 美元。26.5%的患者因并发症再次住院，导致额外费用 10356 美元。预计前采集程序费用为 2522 美元，2 天采集费用为 5160 美元，后采集阶段费用为 8040 美元。我们的分析表明，减少 1 天的采集可以节省 6600 美元。我们还对 16 例接受改良 hyper-CVAD 方案再动员的 MM 患者进行了回顾性分析。动员成功，87.5%的患者成功。我们的分析确定动员、前采集、采集和后采集阶段的费用分别为 24968 美元、2522 美元、6158 美元和 12060 美元。
优化 HSC 动员方案以降低失败率不仅将使患者受益，还将降低整体医疗成本。
