Clinical Immunotherapeutics

, Volume 2, Issue 3, pp 192–205 | Cite as

Economic Effect of Myeloid Growth Factors on Cancer Treatment

  • John Glaspy
Disease Treatment Review

Summary

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.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Armitage J. Editorial. Oncol Times 1993; XV(4): 1Google Scholar
  2. 2.
    Fox EP, Williams SD, Einhorn LH, et al. Incidence of granulocytopenic fever (GCPF) with conventional chemotherapy (CT) of small cell lung cancer (SCLC) and cost impact of G-CSF [abstract]. Proc Annu Meet Am Soc Clin Oncol 1993; 12: A1487Google Scholar
  3. 3.
    Antman KS, Griffin JD, Elias A, et al. Effect of recombinant human granulocyte-macrophage colony-stimulating factor on chemotherapy induced myelosuppression. N Engl J Med 1988; 319: 593–8PubMedCrossRefGoogle Scholar
  4. 4.
    Gabrilove JL, Jakubowski A, Scher H, et al. Effect of granulocyte colony-stimulating factor on neutropenia and associated morbidity due to chemotherapy for transitional-cell carcinoma of the urothelium. N Engl J Med 1988; 318: 1414–22PubMedCrossRefGoogle Scholar
  5. 5.
    Crawford J, Ozer H, Stoller R, et al. Reduction by granulocyte colony stimulating factor of fever and neutropenia induced by chemotherapy in patients with small-cell lung cancer. N Engl J Med 1991; 315: 164–70CrossRefGoogle Scholar
  6. 6.
    Trillet-Lenoir V, Green J, Manegold C, et al. Recombinant granulocyte colony stimulating factor reduces the infectious complications of cytotoxic chemotherapy. Eur J Cancer 1993; 29A: 319–24PubMedCrossRefGoogle Scholar
  7. 7.
    Glaspy JA, Bleecker G, Crawford J, et al. The impact of therapy with filgrastim (recombinant granulocyte colony-stimulating factor) on the health care costs associated with cancer chemotherapy. Eur J Cancer 1993; 29ASuppl. 7: S23–30PubMedCrossRefGoogle Scholar
  8. 8.
    Crawford J, Kreisman H, Garewal H, et al. A pharmacodynamic investigation of recombinant human granulocyte colony-stimulating factor (r-methuG-CSF) schedule variation in patients with small-cell lung cancer (SCLC) given CAE chemotherapy [abstract]. Proc Annu Meet Am Soc Clin Oncol 1992; 11: A1005Google Scholar
  9. 9.
    Kawakami M, Tsutsumi H, Kumakawa T, et al. Levels of serum granulocyte colony-stimulating factor in patients with infections. Blood 1990; 76: 1962–4PubMedGoogle Scholar
  10. 10.
    Watari K, Asano S, Shirafuji N, et al. Serum granulocyte colony-stimulating factor levels in healthy volunteers and patients with various disorders as estimated by enzyme immunoassay. Blood 1989; 73: 117–22PubMedGoogle Scholar
  11. 11.
    Shirafuji N, Asano S, Matsuda S, et al. A new bioassay for human granulocyte colony-stimulating factor (hG-CSF) using murine myeloblastic NFS-60 cells as targets and estimation of its levels in sera from normal healthy persons and patients with infectious and hematological disorders. Exp Hematol 1989; 17: 116–9PubMedGoogle Scholar
  12. 12.
    Omori F, Okamura S, Shimoda K, et al. Levels of human serum granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor under pathological conditions. Biotherapy 1992; 4: 147–53PubMedCrossRefGoogle Scholar
  13. 13.
    Silver GM, Gamelli RL, O’Reilly M. The beneficial effect of granulocyte colony-stimulating factor (G-CSF) in combination with gentamycin on survival after Pseudomonas burn wound infection. Surgery 1989; 106: 452–6PubMedGoogle Scholar
  14. 14.
    Morstyn G, Cebon J, Layton J, et al. Cytokines in infection and as anticancer agents [abstract]. Ann Hematol 1991; 29: A96Google Scholar
  15. 15.
    Maher D, Green M, Bishop J, et al. Randomized, placebo-controlled trial of filgrastim (r-metHuG-CSF) in patients with febrile neutropenia (FN) following chemotherapy (CT) [abstract]. Proc Annu Meet Am Soc Clin Oncol 1993; 12: A1498Google Scholar
  16. 16.
    Lyman GH, Lyman CG, Sanderson RA, et al. Decision analysis of hematopoietic growth factor use in patients receiving cancer chemotherapy. J Natl Cancer Inst 1993; 85: 488–93PubMedCrossRefGoogle Scholar
  17. 17.
    Ariad S, Geffen D. Role of colony-stimulating factors during high dosage chemotherapy. Clin Immunother 1: 449–59Google Scholar
  18. 18.
    Nemunaitis J, Rabinowe SN, Singer JW, et al. Recombinant granulocyte-macrophage colony-stimulating factor after autologous bone marrow transplantation for lymphoid cancer. N Engl J Med 1991; 324: 1773–8PubMedCrossRefGoogle Scholar
  19. 19.
    Gulati SC, Bennett CL. Granulocyte-macrophage colony-stimulating factor (GM-CSF) as adjunct therapy in relapsed Hodgkin disease. Ann Intern Med 1992; 116: 177–82PubMedGoogle Scholar
  20. 20.
    Sheridan WP, Morstyn G, Wolf M, et al. Granulocyte colony-stimulating factor and neutrophil recovery after high-dose chemotherapy and autologous bone marrow transplantation. Lancet 1989; 2: 891–5PubMedCrossRefGoogle Scholar
  21. 21.
    Schriber JR, Negrin RS, Chao NJ, et al. The efficacy of granulocyte colony-stimulating factor following autologous bone marrow transplantation for non-Hodgkin’s lymphoma with monoclonal antibody purged bone marrow. Leukemia 1993; 7: 1491–5PubMedGoogle Scholar
  22. 22.
    Passos-Coelho J, Davidson NE, Noga S, et al. G-CSF accelerates hematopoietic recovery (HR) after high-dose chemotherapy (HDC) and 4-hydroperoxycyclophosphamide (4HC) purged autologous bone marrow transplantation (pABMT) in patients (pts) with metastatic breast cancer (MBC) [abstract]. Proc Annu Meet Am Soc Clin Oncol 1993; 12: A1614Google Scholar
  23. 23.
    Laughlin MJ, Kirkpatrick G, Sabiston N, et al. Hematopoietic recovery following high-dose combined alkylating-agent chemotherapy and autologous bone marrow support in patients in phase-I clinical trials of colony-stimulating factors: G-CSF, GM-CSF, IL-1, IL-2, M-CSF. Ann Hematol 1993; 67: 267–76PubMedCrossRefGoogle Scholar
  24. 24.
    Elias AD, Ayash L, Anderson KC, et al. Mobilization of peripheral blood progenitor cells by chemotherapy and granulocyte-macrophage colony-stimulating factor for hematologic support after high-dose intensification for breast cancer. Blood 1992; 79: 3036–44PubMedGoogle Scholar
  25. 25.
    Sheridan WP, Begley CG, Juttner CA, et al. Effect of peripheral-blood progenitor cells mobilised by filgrastim (G-CSF) on platelet recovery after high-dose chemotherapy. Lancet 1992; 339: 640–4PubMedCrossRefGoogle Scholar
  26. 26.
    Chao NJ, Schriber JR, Grimes K, et al. Granulocyte colony-stimulating factor ‘mobilized’ peripheral blood progenitor cells acccelerate granulocyte and platelet recovery after high-dose chemotherapy. Blood 1993; 81: 2031–5PubMedGoogle Scholar

Copyright information

© Adis International Limited 1994

Authors and Affiliations

  • John Glaspy
    • 1
  1. 1.Department of Medicine, UCLA School of MedicineDivision of Hematology OncologyLos AngelesUSA

Personalised recommendations