PharmacoEconomics

, Volume 20, Issue 10, pp 665–674 | Cite as

Economic Analysis of Filgrastim Use for Patients with Acute Myeloid Leukaemia in the UK

A Comparison of Collection Methods of Resource Use Data
  • Bo Standaert
  • Janet Goldstone
  • Z. John Lu
  • Moshe Haim Erder
  • John Liu Yin
Original Research Article

Abstract

Background: A clinical trial of patients with de novo acute myeloid leukaemia (AML) showed that haematopoietic support with filgrastim (granulocyte colony-stimulating factor, G-CSF) following induction and consolidation chemotherapy accelerated recovery from neutropenia. The clinical benefits included reductions in infections, anti-infective therapy and length of hospital stay.

Objective: The objective of this economic analysis is 2-fold. First, it aims to determine if the observed clinical benefits from the use of filgrastim would lead to cost savings from the perspective of a healthcare institution in the UK. Second, the analysis compares the results of two methods on collection of resource use data.

Design: A retrospective cost-minimisation analysis was undertaken based on the clinical results of all UK patients enrolled in the trial. Two cost models were developed: a model based only on the medical resource use collected in the case report forms (the CRF model); and a model based on all medical resources collected from patient medical files (the PF Model). Treatment costs of AML between filgrastim and the placebo arm were compared for the first induction cycle as well as the first induction and the first consolidation cycles combined. Results from the two models were compared.

Setting and Patients: The CRF model was applied to two samples of patients: all UK patients (n = 82) and patients enrolled at one centre [the Manchester Royal Infirmary (MRI) (n = 30)], whereas the PF model was applied to the MRI patient sample only.

Results: For all UK patients, using the CRF model, the filgrastim-treated arm produced cost savings of £747 (9.0%) and £2135 (14.4%) [1998 values] per patient in the first induction cycle and in the induction and consolidation cycles combined, respectively. For the patients at MRI the CRF model resulted in cost savings with filgrastim of £177 (2.2%) and £414 (3.2%) per patient respectively. Using the PF model the savings at MRI were £910 (8.6%) and £1285 (8.0%) per patient, respectively.

Conclusion: Use of filgrastim in the treatment of AML in the UK may result in net cost savings. A retrospective analysis using total resources obtained through patient files produced higher cost savings estimates than that obtained by resources noted in the CRFs. The models based on PF resource data may be more reliable because they are more comprehensive. However, the cost estimates in this study may have been impacted by sample size, site characteristics, disease and treatment settings. Therefore, further evaluation on the methods for collecting resource use data in larger, multicentred studies is warranted.

Notes

Acknowledgements

Dr John Liu Yin, with his assistant Jannet Goldstone at MRI, participated in an AMGEN-sponsored, phase III clinical trial comparing filgrastim versus placebo in AML. The clinical results of this study were published in reference 11. There was no extra funding from AMGEN for conducting this economic analysis. Bo Standaert, Z. John Lu and Moshe Haim Erder are from the Health Economics Department at AMGEN.

References

  1. 1.
    Parkin DM, Muir CS, Whelan SL, et al. Cancer incidence in five continents, 1990–1995. Lyon: International Agency on Research of Cancer, 1996Google Scholar
  2. 2.
    Mayer RJ, Davis RB, Schiffer CA, et al. Intensive post-remission chemotherapy in adults with acute myeloid leukemia. N Engl J Med 1994; 331: 896–903PubMedCrossRefGoogle Scholar
  3. 3.
    Harousseau JL, Cahn JY, Pignon B, et al., for The Groupe Ouest Est Leucémies Aiguës Myéloblastiques (GOELAM). Comparison of autologous bonemarrowtransplantation and intensive chemotherapy as postremission therapy in adult acute myeloid leukemia. Blood 1997; 90 (8): 2978–86PubMedGoogle Scholar
  4. 4.
    Büchner T, Hiddemann W, Löffler G, et al. Improved cure rate by very early intensification combined with prolonged maintenance chemotherapy in patients with acute myeloid leukemia: data from the AML Cooperative Group. Semin Hematol 1991; 28 (3 Suppl. 4): 76–9PubMedGoogle Scholar
  5. 5.
    Bodey GP, Rodriguez V, Chang HY, et al. Fever and infection in leukaemic patients. A study of 494 consecutive patients. Cancer 1978; 41 (4): 1610–22PubMedCrossRefGoogle Scholar
  6. 6.
    Pui CH, Boyett JM, Hughes WT, et al. Human granulocyte colony-stimulating factor after induction chemotherapy in children with acute lymphoblastic leukaemia. N Engl J Med 1997; 336: 1781–7PubMedCrossRefGoogle Scholar
  7. 7.
    Godwin JE, Kopecky K, Head DR, et al. A double-blind, placebo-controlled trial of granulocyte colony-stimulating factor in elderly patients with previously untreated acute myeloid leukaemia. A SWOG Study. Blood 1998; 91: 3607–15PubMedGoogle Scholar
  8. 8.
    Rowe JM, Anderson JW, Mazza JJ, et al. A randomised placebo-controlled phase III study of granulocyte-macrophage colony-stimulating factor in adult patientswith acute myelogenous leukemia: a study of the ECOG. Blood 1995; 85: 457–62Google Scholar
  9. 9.
    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 (3): 319–24PubMedCrossRefGoogle Scholar
  10. 10.
    Harousseau JL, Witz F, Lioure B, et al. Granulocyte Colony-Stimulating Factor After Intensive Consolidation Chemotherapy in Acute MyeloidLeukemia: Results of a Randomized Trial of the Groupe Ouest-Est Leucémies Aiguës Myéloblastiques. J Clin Oncol 2000; 18 (4): 780–7PubMedGoogle Scholar
  11. 11.
    Heil G, Hoelzer D, Sanz MA, et al. A randomized, double-blind, placebo-controlled phase III study of filgrastim in remission induction and consolidation therapy for adults with de novo acute myeloid leukemia. Blood 1997; 90 (12): 4710–8PubMedGoogle Scholar
  12. 12.
    Chartered Institute of Public Finance and Accountancy, editors. The health service financial database 1998 [computerized database; CD-ROM]. Croydon, UK: Institute of Public Finance, 1998Google Scholar
  13. 13.
    Monthly Index of medical specialities, November 1998. London: Haymarket Publishing Services Ltd, 1998Google Scholar
  14. 14.
    Manchester Royal Infirmary database system. Hospital administration [computer program]. Manchester: B-plan Software, 2002Google Scholar
  15. 15.
    National Blood Service, Manchester Centre. Contract prices for the financial year 1997–1998 [online]. Available at URL: http://www.blood.co.uk [Accessed 1997 Jun 9]Google Scholar
  16. 16.
    Briggs AH, Wonderling DE. Pulling cost-effectiveness analysis up by its bootstraps: non-parametric techniques for estimating confidence intervals around cost-effectiveness ratios. Health Econ 1997; 6 (4): 327–40PubMedCrossRefGoogle Scholar
  17. 17.
    Bennett CL, Hynes DM, Godwin JE, et al. Economic analysis of granulocyte colony-stimulating factor as adjunct therapy for older patients with AML: estimates froma SWOG clinical trial [abstract]. Proceedings of the 40th Annual Meeting of the American Society of Hematology; 1998 Dec 4–8; Miami Beach (FL), 2538aGoogle Scholar
  18. 18.
    Bennett CL, Stinson TJ, Tallman MS, et al. Economic analysis of a randomised placebo-controlled phase III study of granulocyte macrophage colony stimulating factor in adult patients with acute myelogenous leukaemia. Ann Oncol 1999; 10: 177–82PubMedCrossRefGoogle Scholar
  19. 19.
    Bassan R, Lerede T, Di Bona E, et al. Granulocyte colony-stimulating factor after or during an intensive remission induction therapy for adult acute lymphoblastic leukemia: effects, role of patient pretreatment characteristics, and costs. Leuk Lymphoma 1997; 26 (1): 153–61PubMedGoogle Scholar
  20. 20.
    Uyl-de-Groot CA, Lowenberg B, Vellenga E, et al. Cost-effectiveness and quality-of-life assessment of GM-CSF as an adjunct to intensive remission induction chemotherapy in elderly patients with acute myeloid leukaemia. Br J Haematol; 100 (4): 629–36Google Scholar
  21. 21.
    Lu ZJ, Luo R, Erder H, et al. Cost impact of filgrastim as an adjunct to chemotherapy for patients with acute myeloid leukemia (AML) [abstract]. Blood 1997; 90 (10 Suppl. I): 72a–3aGoogle Scholar
  22. 22.
    Noens L, Fillet G, Zachée P, et al. Cost of AML treatment in Belgium: results of a randomised trial with and without filgrastim use [abstract]. Value Health 1999; 2 (5): 379CrossRefGoogle Scholar

Copyright information

© Adis International Limited 2002

Authors and Affiliations

  • Bo Standaert
    • 1
  • Janet Goldstone
    • 2
  • Z. John Lu
    • 1
  • Moshe Haim Erder
    • 1
  • John Liu Yin
    • 2
  1. 1.Department of Health EconomicsAmgen Inc.Thousand OaksUSA
  2. 2.University Department of HaematologyManchester Royal InfirmaryManchesterUK

Personalised recommendations