OBJECTIVES

Stem cell mobilization and apheresis (SCMA) is a costly and time consuming component of hematopoietic cell transplantation (HCT) for patients and healthcare providers but no consensus on standard practice exists. We explored the cost implications of the Levine Cancer Institute (LCI) SCMA as compared with guidelines published by the American Society of Bone Marrow Transplantation (ASBMT).

METHODS

Using data from 234 consecutive autologous SCMA procedures from March 2014 through December 2017, we constructed a cost calculator based on the LCI protocol which included an alternative strategy for the administration of plerixafor (Px), longer apheresis times, and an additional dose of granulocyte colony stimulating factor (GCSF) based on peripheral blood CD34+ cell count on the fourth evening of the mobilization (if < 50 cells/µl). With LCI patient mobilization and collection data, we computed the LCI and ASBMT costs including drug costs, costs of personnel, laboratory costs, cryopreservation costs, and patient and caregiver travel time and lost wages. Assuming ASBMT guidelines and recommendations for autologous HCT are the best approximation to standard practice, we compared cost differences between the LCI protocol and ASBMT.

RESULTS

Using the LCI protocol, 181 patients collected in 1 day of apheresis, 51 in 2 days, and 2 in 3 days. The LCI protocol with 1 day of apheresis saves approximately $4,600 or 20% as compared with ASBMT recommendations without Px and the standard 3 days of collection; adding Px, the LCI protocol saves $16,000 or 46%.

CONCLUSIONS

This innovative approach to autologous SCMA demonstrates cost savings as compared with ASBMT recommendations and guidelines. The LCI protocol helped to save patients and caregivers nearly two days of lost wages and travel time. Further study is needed to understand the most impactful components of the algorithm and its impact on outcomes including mobilization failures.