Cost-analysis of high-dose chemotherapy and peripheral blood stem-cell support in patients with solid tumors

Background: The use of High-dose chemotherapy (HDC) with peripheral blood s tem cells (PBSC) rescue in the treatment of solid tumors is controversial, and may be an important determinant of HDC and PBSC use in the future. Unti l the use of these procedures is proven through disease-free survival and o verall survival compared with standard-dose chemotherapy, the associated co st is also under discussion. Patients and methods: We evaluate 27 consecutive patients with solid tumors who underwent HDC and PBSC rescue, through an accurate review of medical r ecords and cost estimate for each patient. Results: Median age was 45 years. Fifteen had breast cancer, six non-Hodgki n's lymphoma and six other solid tumors. The mean hospital lenght of stay w as 21 days and mean cost was 21,445 US dollars (21,232 euro). Mean cost was clearly lower for the 9 patients treated within phase III trials, 17,571 U S dollars (17,747 euro) than for the remaining 18 patients, treated in phas e I-II trials, 22,747 US dollars (22,975 euro) (P < 0.001). The distributio n of costs shows that wages and pharmacy account for 72% of total cost. The distribution of pharmacy costs per patient shows that chemotherapy (56% of pharmacy costs) and antibiotics (26%) account for most of the cost of medi cation. Conclusions: Our cost estimates agree with those of most countries with nat ional health insurance programs, and are lower than those from the USA. As wages and pharmacy account for more than 70% of the costs, the great differ ent among the costs estimates compared are due essentialy to doctors fees o r salary and drugs utilization. Anyway, taking HDC with PBSC rescue as a mo del for a therapy that is more aggressive than standard, and that is associ ated to a possible survival improvement in indications such as relapsed hig h-grade non-Hodgkin's lymphoma, an adequate cost analysis is crucial both t o measure cost-effectiveness and to establish payment to health care provid ers.