Impact of pharmacy practices on the cost of colony-stimulating factor use in pediatric stem cell transplantation: An institution-based analysis

Purpose: An evaluation of colony-stimulating factor (CSF) use in pediatric stem cell transplantation (SCT) was conducted to identify potential cost-ef ficiencies while preserving institutional standards of patient care. Methods: Clinical and pharmacy records of the 55 SCTs performed during fisc al year 1995 were reviewed. Material costs per vial and per microgram, excl usive of preparation or overhead costs, were used. The best costing strateg y was defined as the least expensive stocking and dispensing practice to de liver the drug actually used during the study period. Results: CSFs were used in 35 of 55 transplants; 68% of usage was protocol- mandated to enhance engraftment; the remainder was associated with life-thr eatening complications of SCT. All use was consistent with published eviden ce-based guidelines. Changes in stocking and dispensing practices would res ult in an overall annual savings of $48,162 (fiscal year 1995 dollars), a 3 9% decrease in cost without a change in clinical application. Conclusions: Our analysis demonstrates that stocking and dispensing practic es place significant fiscal burden in the care of pediatric-aged patients a nd must be carefully considered. This analysis presents a model for evaluat ing all components of drug cost from a global perspective, highlighting a n eed for examination of pharmacy and manufacturing as well as clinical pract ices.