Mobilization With Chemotherapy Compared to G-CSF Alone: An Analysis of Resource Use and Cost in Autologous Stem Cell Transplant Patients

Abstract

Objectives: The most common mobilization regimens for autologous stem cell transplant (ASCT) are granulocyte-colony stimulating factor (G-CSF) alone or in combination with chemotherapy. Chemotherapy plus G-CSF has been shown to mobilize more cells than G-CSF alone but often at the expense of costly side effects. The purpose of this study was to evaluate resource use and cost during mobilization for patients mobilized with chemotherapy plus G-CSF vs. G-CSF alone. Methods: Patients 18 years of age or older with evidence of ASCT between January 1, 2000 and December 31, 2006 were identified from a nationally-representative database of private payer medical and pharmacy claims. Patients had to receive apheresis within 60 days prior to ASCT and have a history of multiple myeloma, non-Hodgkin's lymphoma, or Hodgkin's disease; patients also were required to be continuously enrolled in one health plan for at least 90 days pre-ASCT and have no evidence of a prior ASCT. Using claims data, patients were classified into one of two mobilization regimens: G-CSF alone or chemotherapy with G-CSF. Total resource use and direct medical costs were calculated from the time of administration of the mobilization regimen to the first apheresis day; paid claims were used as a proxy for costs and expressed in 2006 US$. Results: 235 ASCT patients were identified; 172 (73%) were mobilized with G-CSF alone and 63 (27%) with chemotherapy and G-CSF. Total mobilization costs were 27% higher among patients mobilized with chemotherapy versus those mobilized with G-CSF alone ($39,686 vs. $31,251, P = 0.020). Patients mobilized with chemotherapy had higher inpatient hospital costs ($8,225 vs. $5,854, P = 0.056), more use of growth factor ($9,217 vs. $6,948, P = 0.003), and higher pharmacy costs ($5,343 vs. $1,484, P<0.001) than patients mobilized with G-CSF alone. Rituximab comprised 48% of pharmacy costs in the chemotherapy and G-CSF group, while the remaining costs were due to chemotherapy drugs, MESNA, and anti-emetics. Excluding rituximab and G-CSF, patients mobilized with chemotherapy had pharmacy costs that were $1,645 higher than patients mobilized with G-CSF alone. Conclusion: ASCT patients mobilized with chemotherapy had higher total mobilization costs than patients mobilized with G-CSF alone. This significant difference in costs was due to more costly hospitalizations and greater use of G-CSF and other pharmaceuticals in patients mobilized with chemotherapy.Tabled 1Total Mobilization Costs for Chemotherapy and G-CSF vs. G-CSF AloneChemotherapy and G-CSFG-CSF AloneMean (SD)Mean (SD)% DifferenceP-valueTotal Mobilization Costs$39,686 (31,188)$31,251 (31,750)27%0.020Inpatient$8,225 (19,214)$5,854 (18,312)41%0.056Outpatient$16,901 (17,085)$16,965 (19,772)0%0.971Pharmacy$14,560 (12,067)$8,432 (13,502)73%<0.001- G-CSF$9,217 (7,069)$6,948 (10,514)33%0.003- Rituximab$2,547 (6,228)$332 (1,625)667%<0.001- Other retail pharmacy$2,797 (2,923)$1,152 (2,644)143%<0.001 Open table in a new tab