Cost-Effectiveness of Preemptive Plerixafor Versus Rescue Plerixafor for Mobilization and Collection of Hematopoietic Stem Cells in Patients With Multiple Myeloma and Lymphoma

IF 2.7 4区医学 Q4 HEMATOLOGY

Journal of Clinical Apheresis Pub Date : 2025-05-03 DOI:10.1002/jca.70026

Roselene Mesquita Augusto Passos, Miriam Allein Zago Marcolino, Júlia Augusto Passos, Vinicius Fernando Calsavara, Leila de Lourdes Martins Perobelli, Alessandro Gonçalves Campolina, Cesar de Almeida-Neto

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Abstract

Background

Plerixafor combined with granulocyte colony-stimulating factor (G-CSF) has shown superior efficacy in mobilizing hematopoietic stem cells (HSCs). However, its widespread use is constrained by high costs, and there is ongoing debate regarding the effectiveness of mobilization strategies. This study evaluated the cost-effectiveness of preemptive versus rescue plerixafor in patients from the Brazilian Public Health Care System with multiple myeloma or lymphoma eligible for autologous stem cell transplantation (ASCT).

Methods

This observational study assessed the costs and clinical outcomes of preemptive and rescue plerixafor strategies. The incremental cost-effectiveness ratio (ICER) was calculated for the percentage of patients with successful optimal or minimal HSC collections, who underwent ASCT and the number of leukapheresis sessions.

Results

The study included 285 patients, 82 in the preemptive and 203 in the rescue group. Preemptive plerixafor resulted in a lower mobilization failure rate, a decreased need for remobilization, a higher proportion of patients progressing to ASCT, and a shorter interval between the beginning of mobilization and ASCT. The incremental cost of preemptive versus rescue plerixafor was US$ 1532.44. The incremental effectiveness observed was 10.1% for minimally successful harvest (ICER US$ 151.28), 4.7% for optimal harvest (ICER US$ 326.05), and 13.1% for patients progressing to ASCT (ICER US$ 116.18). Regarding the number of leukapheresis sessions, preemptive plerixafor was dominated.

Summary

Preemptive plerixafor is a cost-effective strategy compared to rescue plerixafor, offering higher efficacy and lower ICER values, making it a clinically beneficial option despite its higher cost.

Abstract Image

查看原文本刊更多论文

在多发性骨髓瘤和淋巴瘤患者中，先发制人的普立沙福与抢救普立沙福动员和收集造血干细胞的成本效益

普立沙韦联合粒细胞集落刺激因子（G-CSF）对造血干细胞（hsc）的动员具有较好的疗效。然而，它的广泛使用受到高昂费用的限制，并且目前正在就动员战略的有效性进行辩论。本研究评估了来自巴西公共卫生保健系统的适合自体干细胞移植（ASCT）的多发性骨髓瘤或淋巴瘤患者的预防性与救救性plerixafor的成本效益。方法本观察性研究评估了先发制人和抢救普利沙的成本和临床结果。增量成本-效果比（ICER）计算了成功获得最佳或最少HSC的患者的百分比，他们接受了ASCT和白细胞分离次数。结果共纳入285例患者，其中先发组82例，抢救组203例。先发制人的普利沙可降低动员失败率，减少重新动员的需要，提高进展为ASCT的患者比例，缩短开始动员和ASCT之间的间隔。先发制人与救助的增量成本为1532.44美元。观察到最小成功收获的增量有效性为10.1% (ICER $ 151.28)，最佳收获的增量有效性为4.7% (ICER $ 326.05)，进展到ASCT的患者的增量有效性为13.1% （ICER $ 116.18）。在白细胞分离次数方面，以先取多采为主。与抢救性plerixafor相比，先发制人的plerixafor具有更高的疗效和更低的ICER值，尽管其成本较高，但仍是临床有益的选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Apheresis 医学-血液学

CiteScore

2.80

自引率

13.30%

发文量

审稿时长

>12 weeks

期刊介绍： The Journal of Clinical Apheresis publishes articles dealing with all aspects of hemapheresis. Articles welcomed for review include those reporting basic research and clinical applications of therapeutic plasma exchange, therapeutic cytapheresis, therapeutic absorption, blood component collection and transfusion, donor recruitment and safety, administration of hemapheresis centers, and innovative applications of hemapheresis technology. Experimental studies, clinical trials, case reports, and concise reviews will be welcomed.