Peripheral blood progenitor cell transplantation: Economic issues

High-dose chemotherapy with autologous hematopoietic stem cell rescue is an expensive procedure. It is associated with improved long-term survival in many patients with cancer, but concern is growing about its cost and cost- effectiveness. The cost-effectiveness of high-dose chemotherapy depends largely on the magnitude of the difference in survival between it and standard-dose chemotherapy. Several economic analyses reported that the cost- effectiveness ratio of high-dose chemotherapy in the treatment of breast cancer is in the range of or slightly higher than that reported for other widely accepted medical interventions. Most centers are evaluating new strategies to reduce the overall cost of this therapy, including using peripheral blood progenitor cells rather than bone marrow-derived stem cells, optimizing the collection of peripheral blood progenitor cells, and shifting care from the inpatient to the outpatient setting.