Mobilization, collection, and processing of autologous peripheral blood stem cells: Development of a clinical process with associated costs

We surveyed five academic medical centers to develop a clinical process for patients undergoing cytokine mobilization and leukapheresis prior to autol ogous peripheral blood stem cell transplantation. Costs were obtained from three centers and applied to each component of the pathway. Costs were divi ded into three categories: (1) pre-apheresis evaluation; (2) process of aph eresis; (3) postapheresis and peripheral blood stem cells processing. All c enters participated in the development of the leukapheresis pathway. Becaus e charges vary greatly among institutions, costs were determined from three of the institutions and a mean was calculated for each of the components o f the process. Pre-apheresis costs consisted of central line placement, blo od work, and the price of cytokine (rhG-CSF). Costs associated with apheres is included professional fees (for physicians and nurses), leukapheresis wi th stem cell cryopreservation, storage, sterility testing, analysis of circ ulating CD34(+) cell counts, and 1 day of cytokine therapy. The post-aphere sis process included thawing with sterility testing along with CD34(+) cell number analysis and the performance of clonogenic assays. Total costs were as follows: (1) pre-apheresis, $2711; (2) apheresis, $2990; and, (3) post- apheresis/stem cell processing, $754. This survey from five academic medica l centers provides the average costs associated with three main components of the apheresis procedure. Because many patients require multiple apherese s, interventions to achieve target CD34(+) cell collections in as few colle ctions as possible would result in significant cost reduction.