Economic evaluation of plerixafor for stem cell mobilization

Introduction: Autologous peripheral stem cell transplantation (ASCT) with high-dose chemotherapy is a preferred treatment for relapsed non- Hodgkin lymphoma (NHL) patients. Estimated failure rates with current stem cell mobilization (SCM) regimens are 5% to 30%. Granulocyte colony-stimulating factor (G-CSF) with plerixafor (G+P) is superior to G-CSF alone for SCM in heavily pretreated NHL patients. Objectives: To conduct a cost-utility evaluation of G+P versus G-CSF as a method for SCM in patients with diffuse large B-cell lymphoma (DLBCL), the most common subtype of NHL. Methods: A Markov model simulated the care process of DLBCL patients undergoing ASCT using data from the Washington University site of the plerixafor phase III study. Other data and utilities were taken from the literature. Costs were Medicare allowable. Using microsimulation we estimated the incremental cost-utility ratio (ICUR) over the patient's remaining lifetime. Results: The expected lifetime cost of providing care for DLBCL patients using G+P was $25,567 more than G-CSF, but they accumulated 1.74 more quality-adjusted life-years (QALYs) for an ICUR of $14,735 per QALY. In sensitivity analyses this result was robust to clinically relevant changes in assumptions. Conclusions: Using G+P for SCM in ASCT of patients with DLBCL meets accepted standards of cost-effectiveness, primarily because of its effectiveness in SCM.