Autologous peripheral blood progenitor-cell transplantation versus autologous bone marrow transplantation for adults and children with non-leukaemic malignant disease. A randomised economic study

Abstract

A prospective economic analysis of autologous peripheral blood progenitor-cell transplantation (PBPCT) versus autologous bone marrow transplantation (BMT) was performed as part of a randomised clinical trial in 129 patient (adults and children) receiving high-dosage antineoplastic therapy for non-leukaemic malignant disease. The clinical assessment criteria of the study were the duration of thrombocytopenia (< 30 x 10(9)/L and < 50 x 10(9)/L) and of granulocytopenia (< 0.5 x 10(9)/L). The cost of medical resources used was the primary economic end-point. We also calculated the cost of reaching 2 specified haematological end-points: platelet recovery (> or = 30 x 10(9)/L) and granulocyte recovery (> or = 0.5 x 10(9)/L). Economic analysis was based on the French hospital perspective. Haematological recovery was significantly quicker in the PBPCT groups (adults and children) compared with the BMT groups. Economic study revealed that the PBPCT groups were clearly less expensive with regard to costs up to discharge (17% decrease of the average cost for adults and 29% for children) and those associated with specified haematological end-points. The global costs of PBPCT were lower than those of BMT for these adult and paediatric populations. Economic arguments can clearly be added to clinical ones in favour of substitution of autologous PBPCT for autologous BMT. International comparisons of diffusion of PBPCT could be of great interest for further economic research into medical innovation.