Mg. Vicent et al., Comparative cost analysis of autologous peripheral blood progenitor cell and bone marrow transplantation in pediatric patients with malignancies, HAEMATOLOG, 86(10), 2001, pp. 1087-1094
Background and Objectives. This study was conducted in order to compare and
analyze clinical and economic outcomes of autologous transplantation using
bone marrow or peripheral blood as the source of hematopoietic progenitor
cells in pediatric patients with malignancies.
Design and Methods. We collected clinical information and resource utilizat
ion from 131 consecutive autologous transplantations (102 peripheral blood
progenitor cell (PBPC) and 29 bone marrow (BM) transplants) at a single ins
titution between January 1989 and December 1998 in children with a variety
of malignancies. Multivariable linear regression was used to evaluate the a
ssociations between pre-transplantation variables, post-infusion events and
overall costs. A cost-effectiveness analysis of transplantation for acute
lymphoblastic leukemia (ALL) and acute myeloblastic leukemia (AML) patients
was also performed.
Results. Hematopoietic recovery was faster in the PBPCT group (days to neut
rophil and platelet engraftment: 9 and 13, respectively, versus 14 and 21 f
or BMT, p <0.0001). There were less transfusion, antibiotic and parenteral
nutrition requirements and hospital stay was shorter (median 17 days; range
8-38) in the PBPCT group than in the BMT one (median 28 days; range 11-65)
(p <0.0001) resulting in a median lower overall cost for PBPCT (US$ 7895)
compared to BMT (US$ 11820)(p <0.0001). Major determinants of overall costs
for both groups were total body irradiation (TBI)-based conditioning regim
en, days of hospitalization and number of transfused platelets. In PBPCT pa
tients, a graft containing greater than or equal to 5x10(6)/kg CD34(+) cell
s decreased the total cost of transplantation by 27%. Cost-effectiveness wa
s higher for PBPCT than BMT for pediatric AML patients (p <0.0001) whereas
in ALL patients the cost-effectiveness of the two transplant strategies was
not significantly different.
Interpretations and Conclusions. We conclude that, compared to BMT, autolog
ous PBPCT in children is associated not only with clinical benefits but als
o economic advantages. (C) 2001, Ferrata Storti Foundation.