ECONOMIC-ANALYSIS OF A RANDOMIZED CLINICAL-TRIAL TO COMPARE FILGRASTIM-MOBILIZED PERIPHERAL-BLOOD PROGENITOR-CELL TRANSPLANTATION AND AUTOLOGOUS BONE-MARROW TRANSPLANTATION IN PATIENTS WITH HODGKINS AND NON-HODGKINS-LYMPHOMA

Purpose: High-dose chemotherapy (HDC) with peripheral-blood progenitor cell (PBPC) and autologous bone marrow (ABM) transplant (T) has docum ented survival benefits for relapsed Hodgkin's disease (HD) and non-Ho dgkin's lymphoma (NHL). Treatment costs associated with HDC and its su pportive 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 hospit alization 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-mobiliz ed PBPCT versus ABMT. Patients and Methods: Clinical results and resou rce utilization from a randomized clinical trial that compared filgras tim-mobilized PBPCT versus ABMT following carmustine, etoposide, cytar abine, and melphalan (BEAM) HDC for HD and NHL are presented. The tria l was performed in six centers in Germany, the United Kingdom, and Bel gium. Resource utilization data were used to project costs and Massey Cancer Center (MCC) in the United States incurred the cost of treating the cohort. Costs were projected to the United Stares, because the ec onomic implications to United States centers are significant, costs of care vary markedly among countries but resource utilization on this t rial did not, and a randomized trial is unlikely to be performed in th e 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 greater than or equal to 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 av erage cost was $59,314 for each ABMT patient versus $45,792 for each P BPCT patient. Cost savings of $13,521 (23%) were due to shorter hospit alizations with less supportive care. Conclusion: PBPCT is as safe and more effective than ABMT for HD and NHL in the short term. PBPCT repr esents a significant cost savings due to lower autograft collection co sts, shorter hospital stays, and less supportive care. The savings exc eed the costs for filgrastim mobilization and PBPC collection. Actual savings will vary depending on local practice patterns, charges, and c osts. (C) 1997 by American Society of Clinical Oncology.