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. 2021 Aug;56(8):1876-1887.
doi: 10.1038/s41409-021-01251-8. Epub 2021 Mar 22.

Chemotherapy-based versus chemotherapy-free stem cell mobilization (± plerixafor) in multiple myeloma patients: an Italian cost-effectiveness analysis

Carlo Lazzaro  1 , Luca Castagna #  2 , Francesco Lanza #  3 , Daniele Laszlo #  4 , Giuseppe Milone #  5 , Luca Pierelli #  6 , Riccardo Saccardi #  7
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Chemotherapy-based versus chemotherapy-free stem cell mobilization (± plerixafor) in multiple myeloma patients: an Italian cost-effectiveness analysis

Carlo Lazzaro et al. Bone Marrow Transplant. 2021 Aug.

Abstract

Given the availability and efficacy of the mobilizing agent plerixafor in augmenting hematopoietic progenitor cell mobilization with granulocyte colony-stimulating factor (G-CSF), there is a strong case for comparing the cost-effectiveness of mobilization with G-CSF + cyclophosphamide versus G-CSF alone. This study investigated the cost and effectiveness (i.e., successful 4 million-CD34+ collection) of G-CSF alone versus high-dose cyclophosphamide (4 g/m2) + G-CSF mobilization (± on-demand plerixafor) in patients with multiple myeloma (MM) eligible for autograft in Italy. A decision tree-supported cost-effectiveness analysis (CEA) model in MM patients was developed from the societal perspective. The CEA model compared G-CSF alone with cyclophosphamide 4 g/m2 + G-CSF (± on-demand plerixafor) and was populated with demographic, healthcare and non-healthcare resource utilization data collected from a questionnaire administered to six Italian oncohematologists. Costs were expressed in Euro (€) 2019. The CEA model showed that G-CSF alone was strongly dominant versus cyclophosphamide + G-CSF ( ± on-demand plerixafor), with incremental savings of €1198.59 and an incremental probability of a successful 4 million-CD34+ apheresis (+0.052). Sensitivity analyses confirmed the robustness of the base-case results. In conclusion, chemotherapy-free mobilization (± on-demand plerixafor) is a "good value for money" option for MM patients eligible for autograft.

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Conflict of interest statement

CL has received research grants, speaker or consultancy fees from Boehringer Ingelheim Italia S.p.A., CSL Behring S.p.A., Ferring S.p.A., Ipsen S.p.A., Roche S.p.A., Sanofi S.p.A., Santen GmbH, and Shire Italia S.p.A.; LC has received consultancy fees from Sanofi S.p.A.; FL has received consultancy fees from AbbVie s.r.l. and Sanofi S.p.A.; DL has received consultancy fees from Sanofi S.p.A. and Sandoz S.p.A.; GM declares no disclosures; LP has received consultancy fees from Sanofi S.p.A.; RS has received consultancy fees from Sanofi S.p.A.

Figures

Fig. 1
Fig. 1. Tornado chart showing one-way sensitivity analysis (€2019) of G-CSF ± on-demand plerixafor versus cyclophosphamide 4 g/m2 + G-CSF ± on-demand plerixafor.
The base case ICER for G-CSF ± on-demand plerixafor was –€23,192.47 (indicated by the red vertical line) and was strongly dominant. CTX cyclophosphamide, Eff effectiveness, G-CSF granulocyte colony-stimulating factor, ICER incremental cost-effectiveness ratio, PLX plerixafor, Pr probability, w with, wo without.
Fig. 2
Fig. 2. Cost-effectiveness plane showing probabilistic sensitivity analysis (€2019) of G-CSF ± on-demand plerixafor versus cyclophosphamide 4 g/m2 + G-CSF ± on-demand plerixafor.
The base case ICER for G-CSF ± on-demand plerixafor was strongly dominant. G-CSF granulocyte colony-stimulating factor, ICER incremental cost-effectiveness ratio, PLX plerixafor, w with, wo without.
Fig. 3
Fig. 3. Cost-effectiveness acceptability curve showing probabilistic sensitivity analysis (€2019) of G-CSF ± on demand plerixafor versus cyclophosphamide 4 g/m2 + G-CSF ± on-demand plerixafor.
The base case ICER for G-CSF ± on-demand plerixafor was strongly dominant. CTX cyclophosphamide, G-CSF granulocyte colony-stimulating factor, PLX plerixafor, w with, wo without.
Fig. 4
Fig. 4. Cost-effectiveness acceptability frontier showing probabilistic sensitivity analysis (€2019) for GCS-F ± on-demand plerixafor versus cyclophosphamide 4 g/m2 + G-CSF ± on-demand plerixafor.
The base case ICER for GCS-F ± on-demand plerixafor was strongly dominant. GCS-F ± plerixafor was the optimal healthcare program from a threshold value of €0.00 onwards. G-CSF granulocyte colony-stimulating factor, PLX plerixafor, w with, wo without.
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