Stem Cells Appear More Cost Effective Than Marrow

LOS ANGELES--An economic analysis has shown that use of filgrastim-primedperipheral blood progenitor cells (PBPCs) in relapsed lymphomapatients undergoing high-dose chemotherapy is significantly lessexpensive than autologous bone marrow transplantation (ABMT),Thomas J. Smith, MD, said at the American Society of ClinicalOncology (ASCO) annual meeting.

The total cost of treatment was 31% less using PBPCs primed withfilgrastim (G-CSF, Neupogen). "It is rare in this day andage to find a procedure that is not only more effective but alsomore cost effective," said Dr. Smith, of the Medical Collegeof Virginia, Massey Cancer Center, Richmond.

The economic study was based on data from a prospective randomizedclinical trial performed at seven centers in four European countries.This trial compared the two transplant methods in 72 patientswith relapsed Hodgkin's disease or non-Hodgkin's lymphoma (37randomized to receive PBPC and 35 to receive ABMT). Peripheralblood progenitor cells were collected after mobilization by filgrastim.

In this trial, patients who received filgrastim-primed PBPC supporthad significantly shorter hospital stays than those in the ABMTarm (20 days vs 26 days, respectively); faster time to neutrophilrecovery (13 days vs 15 days); faster time to platelet recovery(20 days vs 27 days); and fewer platelet transfusions (5 vs 12).Exposure to blood products (and risk of HIV or hepatitis) wasmarkedly less in the filgrastim-primed PBPC patients. There wasno difference in safety between the two procedures, with one treatment-relateddeath on each arm.

The total estimated cost of treatment for the filgrastim-primedPBPC patients was about $40,000, compared with $58,000 for theABMT group. The $18,000 savings resulted primarily from reducedhospitalization.

"The PBPC patients were out of the hospital an average ofabout a week sooner," Dr. Smith said. He added that the savingsfar exceeded the costs of filgrastim priming and PBPC collection.