Economic Evaluation of Administration of Plerixafor Based on CD34 Positive Cell Measurement

Abstract

Plerixafor is an expensive medicine priced at approximately JPY580,000/24 mg bottle. Hence, from a medical and economic viewpoint, it is essential that plerixafor is administered at the appropriate timing to patients who require it. In this study, we conducted cost-effectiveness analysis, with a focus on situations in which plerixafor was administered from day four after starting administration of the G-CSF preparation or in which plerixafor administration was determined based on the CD34⁺ cell count.

We retrospectively reviewed the medical records of patients with malignant lymphoma or multiple myeloma, who underwent autologous peripheral blood stem cell collection in this hospital between March 2017 and April 2018. Decision tree algorithms were used to analyze cost-effectiveness.

The expected cost of collecting CD34⁺ cells (2 × 10⁶ cells/kg) within two days of apheresis was approximately JPY1.2 million, when plerixafor was administered from day four regardless of the CD34⁺ cell count. However, the expected cost of that was approximately JPY1 million, when plerixafor administration was determined based on the CD34⁺ cell count. Furthermore, even when the parameters affecting the expected cost, such as the drug price of plerixafor, were changed, the expected cost of collecting the CD34⁺ cells when plerixafor administration was determined based on the CD34⁺ cell count was lower than that when plerixafor was administered regardless of the CD34⁺ cell count.