Evaluation of the Clinical Outcome and the Cost-effectiveness of
Cyclosporine Short Infusion versus Continuous Infusion Post Allogenic
Stem Cell Transplantation
Abstract
Aim: This study aimed to assess the feasibility and safety of
administering cyclosporin A (CsA) as a 2-hour, twice-daily intravenous
infusion versus continuous 24-hour infusion in allogeneic hematopoietic
stem cell transplant (HSCT) patients. Methods: A prospective randomized
study was conducted, dividing adult HSCT patients into two groups based
on the CsA administration method. The primary outcomes assessed the
incidence of acute graft-versus-host disease (aGVHD) and CsA-related
adverse events. Secondary outcomes included the correlation between time
concentrations and area under concentration-time curves (AUCs) and
performing a cost-effectiveness analysis. Results: 31 allogeneic HSCT
patients were enrolled, with 38.7% initially diagnosed with acute
myeloid leukemia (AML). There was no significant difference between the
two study groups in developing aGVHD, distribution of different aGVHD
types, transplantation outcomes, and mortality. The obtained AUCs showed
no significant difference between the two infusion methods at all time
points. Regarding the cost-effectiveness, the 2-hour infusion group had
a higher total of quality-adjusted life-years (QALYs) per patient (1.77)
and lower total costs per patient (3802.15 USD) compared to the 24-hour
infusion group (QALYs: 0.74, costs: 13239.22 USD). The incremental
cost-effectiveness ratio (ICER) for the intervention group was -9158.53.
Conclusion: Administering CsA as a 2-hour twice-daily infusion is both
feasible and safe for allogeneic HSCT patients. The study demonstrates
that the 2-hour infusion regimen is non-inferior to the conventional
24-hour infusion in terms of aGVHD incidence and adverse events.
Moreover, 2-hour infusion strategy proves to be more cost-effective.
Further research is necessary to validate these findings and guide
clinical practice.