OBJECTIVES: Collection of adequate numbers of CD34+ cells for autologous stem cell transplantation of multiple myeloma patients continues to be a challenge, and multiple mobilization and apheresis attempts may be required. Uncertainty associated with mobilization may result in financial inefficiencies for facilities related to chair time for differentially reimbursed procedures. This economic model sought to understand the cost and healthcare resource utilization impacts of multiple apheresis attempts via an indirect comparison between plerixafor and motixafortide.

METHODS: The Excel-based model assessed apheresis days associated with mobilization with filgrastim alone or in combination with either plerixafor or motixafortide. Drug costs were from Micromedex, and procedure costs were from CMS.gov. Costs for apheresis days represent a cost per hour average across apheresis procedures, to reflect opportunity loss due to rescheduling events. Apheresis days required were sourced from clinical trials or product labels.

RESULTS: Under base case assumptions of apheresis days required, the planned cost for a patient ranged from $10,154 to $23,350 based on time for a single chair, days required, and drug price for filgrastim alone (4 days; $20,453-$23,350), filgrastim + plerixafor (2 days; $12,628-$33,737), and filgrastim + motixafortide (1 day; $19,016-$20,826). Based on clinical trial data, 54.2% of patients receiving filgrastim + plerixafor and 86.3% of patients receiving filgrastim + motixafortide achieve target stem cell collection on first day. A subsequent, additional day of apheresis was associated with an unplanned, increased cost of $4,913-$14,743 for filgrastim + plerixafor versus $4,413-$4,775 for filgrastim + motixafortide, showing substantial deviation from projected costs.

CONCLUSIONS: The requirement for additional stem cell collections was associated with substantial variations in projected cost for facilities, including the opportunity cost for other procedures. At the practice-level, filgrastim + motixafortide was associated with less cost variability for additional collection days, which may facilitate efficient practice-level planning.