Cost Analysis of Using Plerixafor plus G-CSF Versus Cyclophosphamide plus G-CSF for Autologous
Stem Cell Mobilization in Multiple Myeloma Patients Treated at Memorial Sloan-Kettering Cancer Center
Nelly G. Adel, PharmD, BCOP, BCPS; Elaine Duck, RN, MA, MS; Karen Collum, RN, MSN, OCN; Emily
Mccullagh, NP-C; Lilian Reich, MD; Heather Landau, MD; Sergio Giralt, MD; Hani Hassoun, MD.
Memorial Sloan-Kettering Cancer Center New York, NY
Background
Results
Results
The combination of cyclophosphamide plus G-CSF has been the standard regimen for
Ninety-eight patients received cyclophosphamide and G-CSF while thirty-five patients
Baseline variables
Cyclophosphamide
Plerixafor
autologous stem cell mobilization for multiple myeloma (MM) patients treated at
received plerixafor as first line mobilization regimens.
Eleven patients (11%) were
N98
35
Memorial Sloan-Kettering Cancer Center (MSKCC) for many years. However, with the
readmitted due to cyclophosphamide complications, with an average hospital stay of 6.9
Mean Age
58.1
58.1
recent FDA approval of plerixafor and its proven efficacy for stem cell mobilization in
days, while none in the plerixafor arm was hospitalized Twenty-one (21%) of the
Male/Female
66/32
16/19
patients who have failed a first collection with cyclophosphamide and G-CSF, the use of
cyclophosphamide group failed mobilization and received plerixafor as salvage regimen of
Average Days of G-CSF Use
13.4 (10+3.4)
6.2 (4+2.2)
plerixafor as first line agent has been advocated for patients with MM. Although
which 3 (3.1%) failed again and are considered ultimate failures. Two (6%) patients failed
Re-Hospitalization rate
11 (11%)
0 (0%)
evidence of improved efficacy of such an approach over G-CSF/cyclophosphamide
upfront mobilization with plerixafor and failed salvage mobilization and are considered
Average Days of Re-Hospitalization
6.9
0
mobilization remains paramount, comparison of cost analysis between the 2
ultimate failures (6%). The average number of pheresis sessions performed was 3.4 and
mobilization regimens is also an important parameter that needs to be considered
Failure Rate
21(21%)
2 (6%)
2.2 in the cyclophosphamide and plerixafor upfront groups respectively. In total the
before endorsing plerixafor as first line mobilization agent.
Salvage Regimen used
NN
average cost per patient who received cyclophosphamide was 1.6 times greater than that
Plerixafor
20
of the patients who received plerixafor upfront.
Objectives
Plerixafor + (Bortezomib + Plerixafor)
1
Cyclophosphamide
2
The primary objective of this retrospective analysis is :
Average Number of Pheresis Sessions
3.4
2.2
Ultimate failures
3 (3.1%)
2 (6%)
MM
To compare the cost of administering Cyclophosphamide plus G-CSF versus
N=133
Plerixafor plus G-CSF as upfront mobilization regimen in patient with MM
Conclusion
Plerixafor
This cost analysis indicates that the use of plerixafor upfront for stem cell mobilization
Cyclophosphamide
+
may be more cost effective than the current widely used approach employing
+
G-CSF
cyclophosphamide.
Methods
G-CSF
N=35
The cost difference between the two approaches could be attributed to several factors:
N=98
Cyclophosphamide mobilization requires an initial inpatient hospitalization in our
Rehospitalization
We have undertaken a retrospective review of hospital records of all adult patients with
institution and often results in re-admissions due to expected toxicity.
N=11 (11%)
MM who received cyclophosphamide or plerixafor for stem cell mobilization prior to
The rate of failures, and therefore need for a salvage mobilization appears to be
ASCT at MSKCC between January 2008 and March 2011.
much higher with cyclophosphamide.
Upfront plerixafor was associated with fewer pheresis sessions, and reduced G-CSF
The Electronic Medical Records, The pharmacy database as well as the Billing records
use.
Success
Failed
Failed
Success
were used to obtain patient specific information.
As many institutions administer cyclophosphamide mobilization on an outpatient basis,
77 (79%)
21 (21%)
2 (6%)
33 (94%)
it is important to note that the cost benefit of plerixafor upfront persists, even when
Data Collected included: Patients' demographics, diagnosis, and all standard baseline
upfront hospitalization costs associated with cyclophosphamide mobilization are omitted
characteristics, treatment characteristics, and stem cell collection outcomes. Actual
from the treatment budget, the cost ratio of cyclophosphamide becomes 1.3 times that
Plerixafor
Plerixafor
costs for all drugs, drug administrations, all procedures including all pheresis sessions,
of plerixafor. Overall, this single institution study provides, in the context of current
+
+
all laboratory testing associated with stem cell collection, and all related hospitalizations
clinical practices at MSKCC, the rational for adopting the use of plerixafor as upfront
G-CSF
Cyclophosphamide
were accounted for.
mobilization agent in MM patients.
All costs were calculated using the institution's ratio of cost to charges, and were
Disclosure
normalized and adjusted based on institutional charges for 2010.
Authors of this presentation have no disclosures concerning possible financial or
Ultimate failures
Ultimate failures
personal relationships with commercial entities that may have an indirect or direct
3 (3.1%)
2 (6%)
interest in the subject matter of this presentation.
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