Can Sequential Administration Minimise the Cost of High Dose Chemotherapy?
Objective: To evaluate the potential cost savings of using sequential high dose chemotherapy (HDC), with granulocyte colony-stimulating factor (filgrastim) and stem cell support, rather than single course administration of HDC with bone marrow transplantation (BMT) or peripheral blood stem cell transplantation (PBSCT). Perspective: French public hospital perspective. Methods: Direct medical costs of sequential treatment, estimated on the basis of physical quantities of resources consumed by 95 patients with inflammatory breast cancer (IBC) included in a French pilot multicentric trial (PEGASE 02), were compared with those of historical control groups of patients treated with single course HDC, either with BMT (n = 27) or PBSCT (n = 14). Costs were evaluated in 1998 French francs (1 € = 6.55957 French francs). Results: The total cost of sequential HDC was significantly lower than that for single course HDC both with BMT (−29%; €22 755 vs €32 284; p < 0.001) or PBSCT (−16%; €22 755 vs €27209; p = 0.026). This was mainly due to a reduction in the length of hospitalisation in transplantation units. Conclusion: According to our results, economic arguments cannot be used against the widespread use of sequential HDC for patients with IBC. However, further economic evaluations based on overall and disease-free survivals alongside a randomised clinical trial are still needed to definitively establish the cost effectiveness of sequential administration of HDC.