The myeloid growth factors granulocyte-macrophage colony-stimulating factor (GM-CSF) and granulocyte colony-stimulating factor (G-CSF) have tremendous potential in the treatment of cancer. Because of their relatively high cost per dose, the availability of these factors has raised important issues regarding their effect on healthcare costs. The effects of therapy with GM-CSF and G-CSF on overall healthcare costs will depend upon: (a) the clinical setting in which they are being used; (b) the cost savings, if any, associated with their efficacy; and (c) the dosage and schedule used.
When used to prevent febrile neutropenia in patients receiving standard dosage chemotherapy, the effect of the myeloid growth factors on healthcare costs is dependent upon the risk of febrile neutropenia if the growth factor is not used, and upon the magnitude of risk reduction associated with use of that particular factor. The published data suggest that the use of G-CSF is associated with a 50% reduction in risk of febrile neutropenia. Our analyses suggest that in most settings the use of G-CSF will be cost saving when the risk of febrile neutropenia in untreated patients exceeds 30%.
When used to treat established febrile neutropenia, the available data suggest that the myeloid growth factors may decrease the duration of neutropenia, but that they do not decrease resource consumption to such an extent that they fully offset their acquisition costs.
When used to facilitate chemotherapy dosage intensification, the myeloid growth factors decrease the morbidity of therapy and decrease resource consumption to such an extent that both GM-CSF and G-CSF fully offset their own costs. This is particularly true when these factors are used to mobilise peripheral blood progenitor cells. Used in this fashion, 2 doses of GM-CSF or G-CSF administered to the entire patient population will decrease resource consumption by approximately 1 day in hospital. However, these high dosage chemotherapy regimens remain more costly than standard dosage chemotherapy, with or without growth factor support. The cost effectiveness of the dosage intensification strategy must be measured in terms of patient outcomes, including duration of survival and quality of life.