title: Economic analysis of a phase III study of G-CSF vs placebo following allogeneic blood stem cell transplantation.
abstract: Hematopoietic colony-stimulating factors (CSF) decrease the duration of neutropenia following stem cell transplantation (SCT). With CSF-mobilized allogeneic blood SCT (alloBSCT), the yields of CD34+ cells are several-fold higher than in other SCT settings, raising concern that post-transplant CSF use may be unnecessary. In this study, we estimate the resource and cost implications associated with CSF use following alloBSCT. A cost identification analysis was conducted for 44 patients on a randomized, double-blind placebo-controlled trial of G-CSF following alloBSCT. Study drug was given daily until an absolute neutrophil count (ANC) > or = 1000 cells/microl. Billing information from the time of transplant to day +100 was analyzed. The median number of days to an ANC > or = 500 cells/microl was shorter in the G-CSF arm, 10.5 days vs 15 days (P < 0.001), while platelet recovery and rates of acute graft-versus-host disease (GVHD) and survival were similar. Resource use was similar, including days hospitalized, days on antibiotics, blood products transfused and outpatient visits. Total median post-transplant costs were $76577 for G-CSF patients and $78799 for placebo patients (P = 0.93). G-CSF following allogeneic blood SCT decreased the median duration of absolute neutropenia and did not incur additional costs, but did not result in shorter hospitalizations, or less frequent antibiotic use.
authors.affiliation: Division of Hematology/Oncology, Northwestern University, Chicago, IL, USA.
authors.forename: T J
authors.initials: TJ
authors.lastname: Stinson
authors.forename: J R
authors.initials: JR
authors.lastname: Adams
authors.forename: M R
authors.initials: MR
authors.lastname: Bishop
authors.forename: S
authors.initials: S
authors.lastname: Kruse
authors.forename: S
authors.initials: S
authors.lastname: Tarantolo
authors.forename: C L
authors.initials: CL
authors.lastname: Bennet
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017326:Clinical Trials, Phase III as Topic / Q000191:economics; D004311:Double-Blind Method; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000191:economics* / Q000627:therapeutic use; D019337:Hematologic Neoplasms / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000188:drug therapy / Q000191:economics / Q000209:etiology; D010919:Placebos; D016032:Randomized Controlled Trials as Topic / Q000191:economics
chemical_list: D010919:Placebos; D016179:Granulocyte Colony-Stimulating Factor