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Economic Implications of High Dose Chemotherapy Programs with Autologous Stem Cell Support

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Molecular Biology of Hematopoiesis 5

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Abstract

In the United States, high dose chemotherapy with stem cell support (bone marrow or peripheral blood) is rapidly becoming accepted therapy for many patients with Hodgkin’s disease, non-Hodgkin’s lymphoma, and breast cancer, despite concerns by insurers and patients over high costs and the potential of significant economic burden on the health care system. Issues such as comparative costs and efficacy of supportive care modalities, hematopoietic growth factors, and adjunctive measures such as purging of stem cells are important. Most often these studies have not evaluated the costs and cost-effectiveness of these pharmaceuticals and technologies. Physicians are now under increasing pressures to accept capitated payments for high dose chemotherapy patients. These capitated rates are often significantly lower than the amount that had been charged for the procedure in the previous year. Furthermore, hospital pharmacies are facing cost-containment pressures and need cost-effectiveness data on pharmaceuticals that are used in high-dose chemotherapy programs. In this paper, we address the economic implications of high dose chemotherapy programs.

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References

  1. Kessinger A, Armitage JO, Smith DM et al. High-dose therapy and autologous peripheral blood stem cell transplantation for patients with lymphoma. Blood 1989; 74: 1260–1265.

    PubMed  CAS  Google Scholar 

  2. Elias AD, Ayash L, Anderson KC et al. Mobilization of peripheral blood progenitor cells by chemotherapy and granulocyte macrophage colony stimulating factor for hematologic support after high dose intensification for breast cancer. Blood 1992; 79: 3036– 44.

    Google Scholar 

  3. Jones HM, Jones SA, Watts MJ et al. Development of a simplified single-apheresis approach for peripheral blood progenitor cells. JCO 1994; 12: 1693 – 1702.

    CAS  Google Scholar 

  4. Bennett CL, Armitage J, Armitage G, Vose J, Bierman, Armitage JO, Anderson J. Costs and outcome for autologous bone marrow transplantation at the University of Nebraska Medical Center: 1987– 1991. J Clin One 1995; 13: 969 – 973.

    CAS  Google Scholar 

  5. Henon PR, Liang H, Beck-Wirth G et al. Comparison of hematopoietic and immune recovery after autologous bone marrow or blood stem cell transplants. Bone Marrow Transplant 1992; 9:285– 291.

    PubMed  CAS  Google Scholar 

  6. Peters WP, Ross M, Vrdedenburgh JJ et al. The use of intensive clinic support to permit outpatient support to permit outpatient autologous bone marrow transplantation for breast cancer. Seminars in Oncology 1994; 21 (4 suppl 7): 25 – 31.

    PubMed  CAS  Google Scholar 

  7. Gilbert C, Meisenberg B, Vredenburgh J. Sequential prophylactic oral and empiric once–daily parenteral antibiotics for neurtopenia and fever after high-dose chemotherapy and autologous bone marrow support. J Clin Oncol 1994; 12: 1005 – 11.

    PubMed  CAS  Google Scholar 

  8. Korbling M, Martin H. Transplantation of hemapheresis-derived hematopoietic stem cells. A new concept in the treatment of patients with malignant lymphohematopoietic disorders. Plasma Ther Transfus Technol 1988; 9: 119 – 123.

    Article  Google Scholar 

  9. Jackson JD, Kloster T, Welniak L et al. Peripheral blood derived stem cells can be successfully cryopreserved without using controlled-rate freezing. Advances in Bone Marrow Purging and Processing. Worthington-White DA, Gee AP, Gross S (eds) Wiley-Liss: New York, 1992 pp. 367– 371.

    Google Scholar 

  10. To LB, Shepperd KM, Kimber RJ et al. Single high doses of cyclophosphamide enable the collection of high numbers of hemopoietic stem cells from the peripheral blood. Exp Hematol 1990; 18: 442’ 7.

    PubMed  CAS  Google Scholar 

  11. Passos-Coelho JL, Ross AA, Moss TJ et al, Abscence of breast cancer cells in a single-day peripheral blood progenitor cell collection after priming with cyclophosphamide and granulocyte-macrophage colony stimulating factor. Blood 1995; 85: 1138– 43.

    Google Scholar 

  12. Vose JM, Anderson JR, Kessinger A et al. High dose chemotherapy and autologous hematopoietic stem cell transplantation for aggressive non-Hodgkin’s lymphoma. J Clin Oncol 1993; 11: 1846– 51.

    PubMed  CAS  Google Scholar 

  13. Smith TJ, Hillner BE, Shmitz N et al. Economic analysis of a randomized clinical trial comparing peripheral blood progenitor cells or autologous bone marrow after high dose chemotherapy for recurrent Hodgkin’s disease or lymphoma. Proceedings of ASCO 1995.

    Google Scholar 

  14. Woronoff-Lemsi MC, Limat S, Deconick E, Arveux P, Cahn JY Cost comparative study of peripheral blood progenitor cells and autologous bone marrow transplantation for lyphmomas patients. Proceedings of the American Society of Hematology 1995, 822a.

    Google Scholar 

  15. Faucher C, Fortanier C, Protiere C et al. Comparison of peripheral blood progenitor cells and bone marrow allogeneic transplantation: clinical and cost-effectiveness study. Proceedings of the American Society of Hematology. 1995, 1528a.

    Google Scholar 

  16. Bennett CL, Garfinkle JB, Greenfield S et al. The relation between hospital experience and in hospital mortality for patients with AIDS-related PCP JAMA 1989; 261: 2975 – 9.

    CAS  Google Scholar 

  17. Bennett RL, Gilman SC, George L, Guze A, Bennett CL. Improved Outcomes in Intensive Care Units for AIDS-Related Pneumocystis carinii Pneumonia: 1987- 1991. JAIDS 1993; 6: 1319 – 1328.

    CAS  Google Scholar 

  18. Banta D, Bos M. The relation between quantity and quality with coronary artery bypass graft surgery. Health Policy 1991; 18: 1 – 10.

    Article  PubMed  CAS  Google Scholar 

  19. Stahel RA, Jost LM, Cerny T et al. Randomized study of recombinant human granulocyte colony stimulating factor after high dose chemotherapy and autologous bone marrow transplantation for high risk malignancies. J Clin Oncol 1994; 12: 1931– 8.

    PubMed  CAS  Google Scholar 

  20. Linch DC, Scarffe H, Proctor V et al. Randomized vehicle controlled dose-finding study of glycosylated recombinant human granulocyte colony stimulating factor after marrow transplantation. BMT 1993; 11: 307– 11.

    CAS  Google Scholar 

  21. Luce BR, Singer JW, Wechsler JM et al. Recombinant human granulocyte macrophage colony stimulating factor after autologous bone marrow transplantation for lymphoid cancer: An economic analysis of a randomized double-blind placebo controlled trial. Pharmacoecon 1994; 6: 42– 8.

    Article  CAS  Google Scholar 

  22. Gulati SC, Bennett CL. Granulocyte macrophage colony stimulating factor as adjunct therapy in relapsed Hodgkin’s disease. Ann Int Med 1992; 116: 177– 82.

    PubMed  CAS  Google Scholar 

  23. Gmur J, Random single donor platelet transfusions: Pros and Cons. Plasma Ther Transfus Technol 1986; 7: 463 – 468

    Google Scholar 

  24. Practice parameter for the use of fresh frozen plasma cryoprecipitate, and platelets. JAMA 1994; 271: 777– 781

    Google Scholar 

  25. Herman JH, Klumpp TR, Christman RA, Goldberg SL, Mangan KF. The effect of platelet dose on the outcome of prophylactic platelet transfusion. American Association of Blood Banking presentation, November 1995, New Orleans, Louisiana.

    Google Scholar 

  26. Ganser A, Lindemann A, Ottman OG et al. Sequential in vivo treatment with two recombinant human hematopoietic growth factors (interleukin-3 and granulocyte macrophage colony stimulating factor) as a new therapeutic modality to stimulate hematopoiesis: Results of a phase I study. Blood 1992; 79: 2583 – 2591.

    PubMed  CAS  Google Scholar 

  27. Richard C, Alsar MJ, Calavia AJ et al. Recombinant human GM-CSF enhances T-cell mediated cytotoxic function after ABMT for hematologic malignancies. Bone Marrow Trans 1993; 11: 473 – 8.

    CAS  Google Scholar 

  28. Stewart-Akers AM, Cairns JS, Tweardy DJ, McCarthy SA. Granulcoyte macrophage colony stimulating factor augmentation of T-cell dependent and t-cell receptor-independent thymocyte proliferation. Blood 1994; 83: 713 – 23.

    PubMed  CAS  Google Scholar 

  29. Gulati SC. Purging in Bone Marrow Transplantation. R.G. Landes Company: Georgetown TX, 1993.

    Google Scholar 

  30. Brenner MK, Rill DR, Moen RC et al. Gene marking to trace origin of relapse after autologous bone marrow transplantation. Lancet 1993; 341: 85 – 86.

    Article  PubMed  CAS  Google Scholar 

  31. Bennett CL, Armitage JL, LeSage S, Gulati S, Armitage JO, and Gorin C. Economic Analyses of Clinical Trials in Cancer: Are They Helpful to Policy Makers? Stem Cells 1994; 12: 424 – 29.

    Article  PubMed  CAS  Google Scholar 

  32. Gorin NC, Coiffer B, Hayat M et al. Recombinant granulocyte macrophage colony stimulating factor after high dose chemotherapy and autologous bone marrow transplantation with unpurged and purged marrow in non-Hodgkin’s lymphoma: A double-blind placebo-controlled trial. Blood 1992; 80: 1– 10.

    Google Scholar 

  33. Link H, Brogaerts MA, Carella AM et al. A controlled trial of recombinant human granulocyte macro¬phage colony stimulating factor after total body irradiation, high dose chemotherapy, and autologous bone marrow transplantation for acute lymphoblastic leukemia or malignant lymphoma. Blood 1992; 80: 188 – 94.

    Google Scholar 

  34. Khwaja A, Linch DC, Goldstone AH et al. Recombinant human granulocyte macrophage colony stimulating factor after autologous bone marrow transplantation for malignant lymphoma: A British National Lymphoma Investigation double-blind placebo controlled trial. B J of Hematol 1992; 82: 317–323

    Article  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Lakeside VAMC Chicago, Northwestern University, Chicago, USA

    Charles L. Bennett

  2. University of Nebraska Medical Center, Omaha, Nebraska, USA

    Michael R. Bishop

  3. The New York Hospital, Cornell University, New York, New York, USA

    Subhash C. Gulati

Authors
  1. Charles L. Bennett
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  2. Michael R. Bishop
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  3. Subhash C. Gulati
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Editor information

Editors and Affiliations

  1. The Rockefeller University, New York, New York, USA

    Nader G. Abraham

  2. University of Tokyo, Tokyo, Japan

    Shigetaka Asano

  3. Universität-Gesamthoschschule Essen, Essen, Germany

    Günther Brittinger

  4. Istituto Cantonale di Patologia, Locarno, Switzerland

    Georges J. M. Maestroni

  5. Western Pennsylvania Cancer Institute, Pittsburgh, Pennsylvania, USA

    Richard K. Shadduck

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© 1996 Plenum Press, New york

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Bennett, C.L., Bishop, M.R., Gulati, S.C. (1996). Economic Implications of High Dose Chemotherapy Programs with Autologous Stem Cell Support. In: Abraham, N.G., Asano, S., Brittinger, G., Maestroni, G.J.M., Shadduck, R.K. (eds) Molecular Biology of Hematopoiesis 5. Springer, Boston, MA. https://doi.org/10.1007/978-1-4613-0391-6_6

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  • DOI: https://doi.org/10.1007/978-1-4613-0391-6_6

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4613-8031-3

  • Online ISBN: 978-1-4613-0391-6

  • eBook Packages: Springer Book Archive

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