TY - JOUR
T1 - Economic Impact of Palifermin on the Costs of Hospitalization for Autologous Hematopoietic Stem-Cell Transplant
T2 - Analysis of Phase 3 Trial Results
AU - Elting, Linda S.
AU - Shih, Ya Chen Tina
AU - Stiff, Patrick J.
AU - Bensinger, William
AU - Cantor, Scott B.
AU - Cooksley, Catherine
AU - Spielberger, Ricardo
AU - Emmanoulides, Christos
N1 - Funding Information:
The authors acknowledge the contributions of the participating sites in the original clinical trial and the Agency for Healthcare Research and Quality, which produces the NIS database. This study would not have been possible without these contributions. The authors also acknowledge the editorial assistance of Kathryn Klobnak. The study was conceived by the investigators, all of whom contributed to the interpretation of the data and approved the final version of the manuscript. The study was supported in part by Amgen Inc., the manufacturer of palifermin. The sponsor reviewed and commented on the design of the study and the final manuscript but was not involved in the analysis or interpretation of data, preparation of the manuscript, or in the decision to publish. Dr. Elting has grant support from Amgen and from MGI Pharma. Dr. Bensinger has grant support from Amgen, Celgene, Novartis, Callisto, and Medimmune. He is also a member of the Speakers Bureaus for Celgene and Millenium. Dr. Spielberger is a member of the Speaker’s Bureau for Amgen. Dr. Stiff is a member of the Speakers Bureau and has grant support from Amgen.
PY - 2007/7
Y1 - 2007/7
N2 - A double-blind, randomized trial showed that, compared with placebo, palifermin (recombinant human keratinocyte growth factor) reduced the frequency and duration of oral mucositis in patients with hematologic malignancies undergoing high-dose chemotherapy and total-body irradiation with autologous stem-cell support. This previously published study also showed a significant reduction in the incidence of adverse subsequent outcomes. The objective of this study was to estimate the impact of palifermin prophylaxis on hospital costs of transplantation in the trial. This was a retrospective, economic analysis of estimated costs for a previously published clinical trial. Costs were not collected during the trial. Therefore, we estimated the direct medical costs of hospitalization using hospital charges from similar patients' hospitalization charges selected from the National Inpatient Sample, a population-based, nationally representative sample of hospital claims. Costs were estimated from charges using Medicare's state-specific cost-to-charge ratios. These cost estimates were applied to the outcome data (incidence of febrile neutropenia, bacteremia/fungemia, or pneumonia, and use of total parenteral nutrition) from the clinical trial. Patients were those with hematologic malignancies who received high-dose chemotherapy and total-body irradiation with autologous stem cell transplant. We compared the estimated total hospital costs (in 2005 United States dollars) incurred by patients who received palifermin in the clinical trial with those incurred by patients who received placebo. Costs were analyzed from the provider's perspective. The mean cost of a hospital day in this population varied between $2,834, when no adverse outcomes occurred, and $4,663, when all 4 outcomes occurred. Reductions in adverse outcomes and their associated hospital stay offset the acquisition price of palifermin. A nonsignificant mean savings of $3,595 per patient (95% confidence interval: $2,090-$5,103) was observed. In sensitivity analyses, this observation was robust to all plausible values of per diem hospital costs and hypothetic per diem outpatient costs. In addition to its previously demonstrated clinical benefit, palifermin prophylaxis offers a favorable economic profile among patients with hematologic malignancies who receive total body irradiation and autologous stem cell support.
AB - A double-blind, randomized trial showed that, compared with placebo, palifermin (recombinant human keratinocyte growth factor) reduced the frequency and duration of oral mucositis in patients with hematologic malignancies undergoing high-dose chemotherapy and total-body irradiation with autologous stem-cell support. This previously published study also showed a significant reduction in the incidence of adverse subsequent outcomes. The objective of this study was to estimate the impact of palifermin prophylaxis on hospital costs of transplantation in the trial. This was a retrospective, economic analysis of estimated costs for a previously published clinical trial. Costs were not collected during the trial. Therefore, we estimated the direct medical costs of hospitalization using hospital charges from similar patients' hospitalization charges selected from the National Inpatient Sample, a population-based, nationally representative sample of hospital claims. Costs were estimated from charges using Medicare's state-specific cost-to-charge ratios. These cost estimates were applied to the outcome data (incidence of febrile neutropenia, bacteremia/fungemia, or pneumonia, and use of total parenteral nutrition) from the clinical trial. Patients were those with hematologic malignancies who received high-dose chemotherapy and total-body irradiation with autologous stem cell transplant. We compared the estimated total hospital costs (in 2005 United States dollars) incurred by patients who received palifermin in the clinical trial with those incurred by patients who received placebo. Costs were analyzed from the provider's perspective. The mean cost of a hospital day in this population varied between $2,834, when no adverse outcomes occurred, and $4,663, when all 4 outcomes occurred. Reductions in adverse outcomes and their associated hospital stay offset the acquisition price of palifermin. A nonsignificant mean savings of $3,595 per patient (95% confidence interval: $2,090-$5,103) was observed. In sensitivity analyses, this observation was robust to all plausible values of per diem hospital costs and hypothetic per diem outpatient costs. In addition to its previously demonstrated clinical benefit, palifermin prophylaxis offers a favorable economic profile among patients with hematologic malignancies who receive total body irradiation and autologous stem cell support.
KW - Cancer
KW - Cost of illness
KW - Economic analysis
KW - Palifermin
KW - Stem cell transplant
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U2 - 10.1016/j.bbmt.2007.03.004
DO - 10.1016/j.bbmt.2007.03.004
M3 - Article
C2 - 17580258
AN - SCOPUS:34250207691
SN - 1083-8791
VL - 13
SP - 806
EP - 813
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 7
ER -