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Therapeutic Use of Granulocyte Colony-Stimulating Factors for Established Febrile Neutropenia

Effect on Costs from a Hospital Perspective

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Abstract

Background

The prophylactic use of granulocyte colony-stimulating factors (G-CSFs) reduces the severity and duration of neutropenia and reduces the incidence of febrile neutropenia after cancer chemotherapy. However, the use of G-CSFs, particularly filgrastim, to treat established neutropenia remains controversial. A recent meta-analysis of randomised controlled trials (RCTs) evaluating G-CSF treatment for established febrile neutropenia demonstrated a reduction in prolonged hospitalisations. Because more than one-third of patients in the analysis were hospitalised for at least 10 days, this finding has broad pharmacoeconomic and clinical significance. This analysis presents the potential cost implications of G-CSF treatment for established neutropenia among hospitalised patients.

Methods

Direct medical costs ($US, year 2003 values) related to hospitalisation for established neutropenia were modelled using a hospital perspective and according to two treatment options: (i) no use of G-CSF during the neutropenic episode (control); and (ii) addition of daily G-CSF until neutrophil recovery. Within each option, we modelled the probability of a long stay (≥10 days) and patient survival. The model used three data sets: discharge data from a consortium of academic medical institutions, drug cost data (filgrastim) from Federal payers, and estimates of G-CSF efficacy derived from a meta-analysis of RCTs of treatment in patients with established febrile neutropenia. The lowest expected total cost was predicted for both treatment options; sensitivity analyses and Monte Carlo simulations were used to evaluate the robustness of the model.

Results

The G-CSF arm produced the lowest expected cost, and predicted net estimated savings of $US1046 per neutropenic episode compared with the control strategy. G-CSF was less expensive than the control for most reasonable estimates of cost per day and all lengths of stay (LOS) ≥10 days. G-CSF was the least costly strategy for 73.5% of 10 000 Monte Carlo iterations, while the no-G-CSF control strategy predicted savings in 26.5% of iterations.

Conclusions

This pharmacoeconomic model suggests that therapeutic use of G-CSF should be considered for patients with established neutropenia in order to reduce overall hospital cost. G-CSF treatment may offer substantial potential savings for hospitalised patients with established neutropenia over a wide range of model assumptions. Therapeutic G-CSF use among patients hospitalised for established neutropenia may complement the recommended prophylactic use of these agents for the prevention of neutropenic episodes.

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Acknowledgements

This study was presented, in part, at the 36th Annual Meeting of the American Society of Clinical Oncology, Chicago (IL), 2003. The information contained in this article was based, in part, on the Clinical Data Products Data Base maintained by the University HealthSystem Consortium (UHC). This study received unrestricted research support from Amgen, Inc.

Drs Dale and Lyman are on the speaker’s bureau for Amgen. Drs Lyman, Crawford and Dale have served as consultants and received research support from Amgen, Inc. Dr Cosler has received an honorarium for a presentation sponsored by Amgen, Inc. Drs Kuderer, Culakova and Ms Eldar-Lissai have no conflicts of interest that are directly relevant to the contents of this study. This manuscript was edited by Allison Krug, MPH.

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Authors and Affiliations

  1. Albany College of Pharmacy, Albany, New York, USA

    Leon E. Cosler

  2. James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Box 704, Rochester, New York, 14642, USA

    Leon E. Cosler, Eva Culakova, Nicole M. Kuderer &  Gary H. Lyman

  3. Department of Community and Preventive Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA

    Adi Eldar-Lissai

  4. University of Washington Medical Center, Seattle, Washington, USA

    David Dale

  5. Duke University Medical Center, Durham, North Carolina, USA

    Jeffrey Crawford

Authors
  1. Leon E. Cosler
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  2. Adi Eldar-Lissai
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  3. Eva Culakova
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  4. Nicole M. Kuderer
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  5. David Dale
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  6. Jeffrey Crawford
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  7. Gary H. Lyman
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Corresponding author

Correspondence to Gary H. Lyman.

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Cosler, L.E., Eldar-Lissai, A., Culakova, E. et al. Therapeutic Use of Granulocyte Colony-Stimulating Factors for Established Febrile Neutropenia. Pharmacoeconomics 25, 343–351 (2007). https://doi.org/10.2165/00019053-200725040-00006

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  • DOI: https://doi.org/10.2165/00019053-200725040-00006

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