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
{"title":"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","authors":"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","doi":"10.1002/jca.70026","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>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).</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Summary</h3>\n \n <p>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.</p>\n </section>\n </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 3","pages":""},"PeriodicalIF":2.7000,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jca.70026","citationCount":"0","resultStr":"{\"title\":\"Cost-Effectiveness of Preemptive Plerixafor Versus Rescue Plerixafor for Mobilization and Collection of Hematopoietic Stem Cells in Patients With Multiple Myeloma and Lymphoma\",\"authors\":\"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\",\"doi\":\"10.1002/jca.70026\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>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).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Summary</h3>\\n \\n <p>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.</p>\\n </section>\\n </div>\",\"PeriodicalId\":15390,\"journal\":{\"name\":\"Journal of Clinical Apheresis\",\"volume\":\"40 3\",\"pages\":\"\"},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2025-05-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jca.70026\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Clinical Apheresis\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/jca.70026\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"HEMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Apheresis","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/jca.70026","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"HEMATOLOGY","Score":null,"Total":0}
Cost-Effectiveness of Preemptive Plerixafor Versus Rescue Plerixafor for Mobilization and Collection of Hematopoietic Stem Cells in Patients With Multiple Myeloma and Lymphoma
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.
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.
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