Economic considerations in the use of peripheral blood progenitor cells tosupport high-dose chemotherapy

There has been increasing interest in the de development of strategies to e nhance the number of CD34(+) cells obtained during harvesting of peripheral blood progenitor cells (PBPC) to support high-dose chemotherapy. The strat egies have included the use of chemotherapy plus cytokine for mobilization, and the development of more effective mobilizing cytokine combinations, su ch as stem cell factor plus filgrastim, Although there are costs associated with the implementation of these strategies, there are also predictable co st savings to be realized from the enhanced PBPC yields, Available data sug gest that these cost savings include: $2000 per apheresis prevented, $6000 per back-up bone marrow harvest prevented, and at least $10 200 per remobil ization and apheresis stage prevented. In addition, there is emerging evide nce that the administration of optimal (greater than or equal to 5 x 10(6)/ kg) as opposed to acceptable but suboptimal (>1 x 10(6)/kg but <5 x 10(6)/k g) numbers of CD34(+) PBPC will be associated with decreased supportive car e needs and decreased costs of at least $4500-8000. These economic consider ations should play a role, together with clinical data, in rational decisio n-making with respect to PBPC support.