P-330: STEM CELL MOBILIZATION STRATEGY WITH PEGILGRASTIM FOR STEM CELL TRANSPLANTATION FOR MULTIPLE MYELOMA: A DIRECT COST COMPARISON

Introduction: autologous stem cell transplantation is still standard of care among younger patients with multiple myeloma mainly in low-to-middle income countries. Strategies to improve availability of this procedure such as infusion of fresh stem cell graft are currently in place for this scenario. Here we report our experience with pegfilgrastim mobilization and fresh stem cell infusion for MM first autologous stem cell transplant.

Methods: we conducted a direct cost comparison to estimate the mean cost per stem mobilization procedure among MM patients receiving either filgrastim (10 mcg/Kg/day for 4 days) or pegfilgrastim (single 6 mg dose) followed by plerixafor in a just-in-time approach. We reviewed data on 335 patients that received a mobilization to extract data on resource utilization. Costs for drugs were valued according to the CMED table added 18% taxation practiced at the state of São Paulo, costs for procedures were estimated using the AMB table and market research, all estimates in Brazilian currency (R$). We compared the mean difference for mobilization using bootstrapping, with 10.000 repetitions for each group.

Results: efficacy results were largely overlapping between the two strategies, the mobilization failure rates were 0.6% for both groups (p value = 1), the yield of CD34 / Kg was also similar median 5.17 (95%CI 2.41-10.23) vs. 5.02 (95%CI 2.35-10.94) for filgrastim and peg respectively and therefore we conducted a direct cost comparison. Use of plerixafor however was greater for peg, 57.3% vs. 23.2% (p < 0.001). Median cost per mobilization was lower for pegfilgrastim (Δ – R$ 3360,06 95%CI -30525,15 to + 18939,13).

Conclusions: pegfilgrastim resulted in overall lower costs per mobilization strategy, given maximum expenditure per medication unit that is provided from the CMED table. This value difference might differ significantly over actual values practiced over large purchases, for example.