Surveillance of colony-stimulating factor use in US academic health centers.
OBJECTIVE
To characterize and evaluate hematopoietic colony-stimulating factor (CSF) use, including cost implications, in US academic health centers.


METHODS
An observational study of patients who received granulocyte colony-stimulating factor (G-CSF) or granulocyte-macrophage colony-stimulating factor (GM-CSF) from September 1 to October 15, 1993.


METHODS
Thirty academic health centers in the US.


METHODS
Five hundred sixty-five patients were evaluated.


METHODS
The appropriateness of CSF use was assessed, based on consensus-derived indication guidelines and the Food and Drug Administration-approved product labeling. Indication, type of CSF, and dosage were considered in determining the appropriateness of CSF therapy.


RESULTS
Based on indication evaluation criteria, 71% of CSF use was appropriate, 7% was inappropriate, and 22% was unproven, although the majority of unproven use was deemed promising by the expert panel. Based on dosage evaluation criteria, 51% of CSF use was appropriate, 27% was inappropriate, and 22% was for promising and other unproven indications. More than 90% of the patients studied received G-CSF. Approximately 3.4% of patients who received G-CSF had an adverse event, compared with 22% of those who received GM-CSF. Approximately $791,000 was spent on CSF therapy in the 565 patients: $401,000 (51%) on appropriate indications and doses, $160,000 (20%) on inappropriate doses for appropriate indications, $124,000 (16%) on promising indications, and $106,000 (13%) on unproven or inappropriate indications.


CONCLUSIONS
Substantial costs are incurred currently for CSF therapy without adequate literature support. Further studies are warranted to justify promising but unproven uses of CSFs, as well as to clarify proper dosing, monitoring, and relative safety of CSFs.
Yim
J M
JM
Clinical Practice Advancement Center, University Hospital Consortium, Oak Brook, IL 60521, USA.
Matuszewski
K A
KA
Vermeulen
L C
LC
Ratko
T A
TA
Burnett
D A
DA
Vlasses
P H
PH
D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D016527:Drug Costs; D011307:Drug Prescriptions; D004363:Drug Utilization; D005260:Female; D005334:Fever / Q000188:drug therapy / Q000517:prevention & control; D016179:Granulocyte Colony-Stimulating Factor / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000188:drug therapy / Q000517:prevention & control; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D014481:United States
D016179:Granulocyte Colony-Stimulating Factor; D016178:Granulocyte-Macrophage Colony-Stimulating Factor