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Cost analysis of a randomized stem cell mobilization study in multiple myeloma

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Abstract

Upfront autologous stem cell transplantation (ASCT) is the standard therapy for younger multiple myeloma (MM) patients. MM patients usually undergo stem cell mobilization with cyclophosphamide (CY) followed by granulocyte colony-stimulating factor (G-CSF), or with G-CSF alone. A limited number of randomized studies are available comparing costs of different mobilization strategies. Eighty transplant-eligible patients aged up to 70 years with untreated MM were included in this prospective study. The patients were treated with RVD induction for three 21-day cycles and randomized 1:1 at inclusion into one of the two mobilization arms CY 2 g/m2 + G-CSF [arm A] vs. G-CSF alone [arm B]. Plerixafor was given according to a specific algorithm if needed. Sixty-nine patients who received mobilization followed by blood graft collection were included in the cost analysis. The median total costs of the mobilization phase were significantly higher in arm A than in arm B (3855 € vs. 772 €, p ≤ 0.001). The cumulative median cost of the mobilization and collection phases was significantly lower in arm B than in arm A (8524 € vs. 11,622 €, p = 0.012). There was no significant difference between the arms in the total median costs of ASCT (n = 59) (34,997 € in arm A vs. 31,981 € in arm B, p = 0.118). Mobilization with G-CSF alone seems to be a preferable mobilization method for MM patients in terms of mobilization and apheresis costs. In addition, it requires less hospital resource utilization.

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Acknowledgments

The help of Juha Lievonen, M.D., is gratefully acknowledged.

Author information

Authors and Affiliations

  1. Department of Medicine, Kuopio University Hospital, Kuopio, Finland

    Ville Varmavuo, Raija Silvennoinen & Esa Jantunen

  2. Department of Medicine, Kymenlaakso Central Hospital, Kotkantie 41, 48210, Kotka, Finland

    Ville Varmavuo

  3. Division of Hematology, Comprehensive Cancer Center, Helsinki University and Helsinki University Hospital, Helsinki, Finland

    Raija Silvennoinen & Pekka Anttila

  4. Department of Medicine, Oulu University Hospital, Oulu, Finland

    Marjaana Säily

  5. Department of Internal Medicine, Tampere University Hospital, Tampere, Finland

    Marja Sankelo

  6. Department of Medicine, Turku University Hospital, Turku, Finland

    Mervi Putkonen & Kari Remes

  7. Hospital Pharmacy of Kuopio University Hospital, Kuopio University Hospital, Kuopio, Finland

    Jouni Ahonen

  8. Laboratory of Eastern Finland, Kuopio, Finland

    Eija Mahlamäki & Pentti Mäntymaa

  9. Nordlab Oulu, Medical Research Center, Oulu University Hospital, Oulu, Finland

    Eeva-Riitta Savolainen

  10. University of Turku, Turku, Finland

    Kari Remes

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  1. Ville Varmavuo
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Correspondence to Ville Varmavuo.

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Conflict of interest

VV has received consultancy fees from Roche, Celgene, Amgen, and Sanofi. RS has received a research grant from Celgene and Janssen, honoraria from Celgene, Janssen, and Sanofi. KR has participated in the Medical Advisory Board organized by Amgen and Takeda and has received consultancy fees from Amgen, Celgene, Roche, and Takeda. EJ has received honoraria from Genzyme, Amgen, and Sanofi and has participated in an EU Leadership meeting organized by Genzyme as well as a Medical Advisory Board meeting organized by Amgen and Takeda. The other authors have no conflicts of interest to disclose.

The Finnish Myeloma Study Group-MM02 trial was supported by research funding from Celgene. Celgene also provided the study drug lenalidomide.

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Varmavuo, V., Silvennoinen, R., Anttila, P. et al. Cost analysis of a randomized stem cell mobilization study in multiple myeloma. Ann Hematol 95, 1653–1659 (2016). https://doi.org/10.1007/s00277-016-2772-1

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