Valuing clinical strategies early in development: a cost analysis of allogeneic peripheral blood stem cell transplantation

Allogeneic peripheral blood stem cell transplantation (alloPBSCT) is an eme rging technology. As this technology develops, transplant centers are conce rned with looking for technologic advances that,,ill result in improvements in clinical outcomes and lower costs, We provide comparative estimates of costs and resource use for alloPBSCT in comparison to allogeneic bone marro w transplantation (alloBMT) for persons with hematologic malignancies from the time of harvest to 100 days post transplant. A retrospective, cost-iden tification analysis was conducted for patients in two consecutive phase Ii clinical trials at the University of Nebraska Medical Center. Identical pre parative regimens, graft-versus-host disease prophylaxis, post-transplant h ematopoietic colony-stimulating factor treatment regimens, and discharge cr iteria were used. Total median costs were $18 304 lower for alloPBSCT, with lower costs during recovery; specifically for hospitalization, platelet pr oducts? hematopoietic growth factors, intravenous hyperalimentation, suppor tive care agents, supplies, and antibacterial agents. This study provides p reliminary evidence for short-term cost savings associated with alloPBSCT, However, concerns exist over the potential for higher costs due to prelimin ary reports of higher rates of chronic graft-versus-host disease, as well a s more intensive induction regimens that may result in lower relapse rates, The premature adoption of new technologies based on short-term economic fa ctors, in the absence of adequate clinical trial data, may prove to be ill- advised, particularly for complex medical treatments such as allogeneic tra nsplantation.