Economic considerations in the use of peripheral blood progenitor cells to support high-dose chemotherapy

There has been increasing interest in the development of strategies to enhance the number of CD34+ cells obtained during harvesting of peripheral blood progenitor cells (PBPC) to support high-dose chemotherapy. The strategies have included the use of chemotherapy plus cytokine for mobilization, and the development of more effective mobilizing cytokine combinations, such as stem cell factor plus filgrastim. Although there are costs associated with the implementation of these strategies, there are also predictable cost savings to be realized from the enhanced PBPC yields. Available data suggest that these cost savings include: $2000 per apheresis prevented, $6000 per back-up bone marrow harvest prevented, and at least $10200 per remobilization and apheresis stage prevented. In addition, there is emerging evidence that the administration of optimal (> or = 5 x 10(6)/kg) as opposed to acceptable but suboptimal (>1 x 10(6)/kg but <5 x 10(6)/kg) numbers of CD34+ PBPC will be associated with decreased supportive care needs and decreased costs of at least $4500-8000. These economic considerations should play a role, together with clinical data, in rational decision-making with respect to PBPC support.