Peripheral blood progenitor cell transplantation: impact on the pharmacy workload and budget

Due to reduced engraftment times and significantly shortened hospitalizations, peripheral blood progenitor cell (PBPC) transplantation has reduced the costs associated with autologous transplantation. Several institutions reported a reduction of 20-50% in transplantation cost using PBPCs and an aggressive outpatient program. These savings could be offset by hospital readmissions, but improvements in supportive care such as administration of colony-stimulating factors and broad-spectrum oral antibiotics, and assigning a 24-hour caregiver as a prerequisite for transplantation enable safe performance of outpatient transplantation and limit readmission rates to about 20-40%. At this institution, the effect of this program on the pharmacy has been a shift in staff and drug costs to outpatient cost centers. The transition from inpatient to outpatient care did not necessitate a greater investment in pharmacy staffing, but did require cross-training for inpatient and outpatient pharmacists. Future management of outpatient transplantation will apply a cooperative care philosophy that will rely to a large extent on patient care by family members and on a multidisciplinary model of seamless care.