Yerrabothala Swaroopa, Talebian Laleh, Klinker Karen, Hickman Joshua, Hill John M, Hayes Christi, Lowrey Christopher, Szczepiorkowski Zbigniew M, Meehan Kenneth R
Division of Hematology and Oncology and the, The Blood and Marrow Transplant Program, Lebanon, New Hampshire 03756.
Cellular Therapy Center and Blood Bank/Transfusion Medicine Service, Dartmouth Hitchcock Medical Center, Dartmouth Medical School, and the Norris Cotton Cancer Center, Lebanon, New Hampshire 03756.
J Clin Apher. 2018 Jun;33(3):310-315. doi: 10.1002/jca.21606. Epub 2017 Nov 28.
Extracorporeal photopheresis (ECP) is an established therapy for the treatment of graft-versus-host-disease (GVHD) following an allogeneic stem cell transplant. We performed a prospective analysis of patients receiving ECP treatment for GVHD to identify a clinical pathway and resource utilization of this process. The cohort included consecutive allogeneic stem cell recipients with GVHD. ECP was performed using the CELLEX Photopheresis System or the UVAR XTS Photopheresis System (Therakos, Inc, Exton, PA). A clinical pathway was developed and a time and motion study was conducted to define the resource utilization and costs associated with ECP. Patients were treated with either CELLEX (n = 18 procedures) or UVAR (n = 4 procedures). Total time commitment for each procedure for the 2 machines differed. The time for ECP was 117 min (median, range: 91-164 min) using CELLEX and 161 min (median; range: 140-210) using the UVAR-XTS machine. Total costs of each ECP procedure were $3420.50. There is a considerable time commitment of the patient and the clinical staff when employing ECP to treat GVHD. ECP costs are significant considering this is a prolonged therapy continued for several months. With this finalized pathway and costs, we have a standardized clinical pathway for the treatment of GVHD. We are addressing minimizing resource utilization while emphasizing quality care for these patients.
体外光化学疗法（ECP）是一种用于治疗异基因干细胞移植后移植物抗宿主病（GVHD）的既定疗法。我们对接受ECP治疗GVHD的患者进行了前瞻性分析，以确定该治疗过程的临床路径和资源利用情况。该队列包括连续的患有GVHD的异基因干细胞接受者。使用CELLEX光化学疗法系统或UVAR XTS光化学疗法系统（Therakos公司，宾夕法尼亚州埃克斯顿）进行ECP。制定了临床路径并进行了时间与动作研究，以确定与ECP相关的资源利用和成本。患者分别接受CELLEX治疗（n = 18次治疗）或UVAR治疗（n = 4次治疗）。两台机器每次治疗的总时间投入不同。使用CELLEX进行ECP的时间为117分钟（中位数，范围：91 - 164分钟），使用UVAR - XTS机器的时间为161分钟（中位数；范围：140 - 210分钟）。每次ECP治疗的总成本为3420.50美元。采用ECP治疗GVHD时，患者和临床工作人员需要投入大量时间。考虑到这是一种持续数月的长期治疗，ECP的成本很高。有了这个最终确定的路径和成本，我们有了一个治疗GVHD的标准化临床路径。我们正在致力于在强调为这些患者提供优质护理的同时尽量减少资源利用。
