Extracorporeal photopheresis for graft versus host disease: Identifying a clinical pathway and associated resource utilization

Abstract

Extracorporeal photopheresis (ECP) is an established therapy for the treatment of graft-versus-host-disease (GVHD) following an allogeneic stem cell transplant. We performed a prospective analysis of patients receiving ECP treatment for GVHD to identify a clinical pathway and resource utilization of this process. The cohort included consecutive allogeneic stem cell recipients with GVHD. ECP was performed using the CELLEX Photopheresis System or the UVAR XTS Photopheresis System (Therakos, Inc, Exton, PA). A clinical pathway was developed and a time and motion study was conducted to define the resource utilization and costs associated with ECP. Patients were treated with either CELLEX (n = 18 procedures) or UVAR (n = 4 procedures). Total time commitment for each procedure for the 2 machines differed. The time for ECP was 117 min (median, range: 91-164 min) using CELLEX and 161 min (median; range: 140-210) using the UVAR-XTS machine. Total costs of each ECP procedure were $3420.50. There is a considerable time commitment of the patient and the clinical staff when employing ECP to treat GVHD. ECP costs are significant considering this is a prolonged therapy continued for several months. With this finalized pathway and costs, we have a standardized clinical pathway for the treatment of GVHD. We are addressing minimizing resource utilization while emphasizing quality care for these patients.

Cost comparison of extracorporeal photopheresis technologies at the European Institute of Oncology

“…Similar differences between average treatment times, to those reported in this study and by Azar et al (120 minutes), 2 have been reported for CELLEX online procedures elsewhere (113, 135, and 117 minutes) 15,16 . The ability of other centers to perform only one offline ECP procedure per day, per bed, 14 is in line with the IEO, and highlights the potential time benefit of switching to integrated online ECP procedures.…”

“…Additionally, the lack of a direct comparator group is a limitation of this study, as these analyses relied on comparisons with previously published data. However, the estimated median time to conduct one CELLEX ECP procedure reported by Azar et al was in line with recent observations 16 . The use of TDABC methodology is a strength of this study as this approach has a demonstrated ability to accurately capture the cost of care delivery, at the level of care processes, while having a small resource burden 13 .…”

Inline extracorporeal photopheresis: evaluation of cell collection efficiency

“…In literature, there are detailed data on clinical efficacy, on the optimization of the patients’ paths and on the cost effectiveness of the inline procedure, while we found very few data about collection efficiency.…”

Inline and offline extracorporeal photopheresis: Device performance, cell yields and clinical response

“…To date, the choice of inline or offline method is conditioned also by economic considerations. 29,30 In relation to ECP we have found many costeffectiveness analyses that take into account the use of resources calculated mainly in economic terms. The inline system is associated with higher set-up costs while the offline system is associated with higher personnel and time costs.…”

“…On the other hand offline ECP does not require a dedicated device and therefore can be easily implemented in apheresis facility, it collects high cell yields but implies longer procedure and greater operator intervention. To date, the choice of inline or offline method is conditioned also by economic considerations 29,30 . In relation to ECP we have found many cost‐effectiveness analyses that take into account the use of resources calculated mainly in economic terms.…”