Cost analyses of adjunct colony stimulating factors for older patients with acute myeloid leukaemia : can they improve clinical decision making?
Colony stimulating factors (CSF) have been shown to reduce the duration of neutropenia following intensive chemotherapy in a variety of settings, with many of these studies targeting older patients with leukaemia. We review the clinical and economic findings for use of growth factors for older adults with acute myelogenous leukaemia (AML). The cost analyses were based on the perspective of the third party payer. One study, conducted by the Southwest Oncology Group (SWOG) randomised 207 AML patients to receive granulocyte colony-stimulating factor (G-CSF) or placebo and found no significant difference in number of infections and in days of hospitalisation, 3 fewer days with an absolute neutrophil count <500 cells/microL with G-CSF, and an estimated incremental cost of only US 120 dollars with G-CSF over placebo (1997 costs). A second study, conducted by the Eastern Cooperative Oncology Group (ECOG), randomised 119 AML patients to receive granulocyte-macrophage colony-stimulating factor (GM-CSF) or placebo and found a reduction in severe infections, 4 fewer days with an absolute neutrophil count <500 cells/microL, no significant difference in the duration of hospitalisation, and estimated cost savings of US 2310 dollars with GM-CSF (1997 costs). These data may be useful to physicians faced with concerns over clinical and economic factors associated with CSF use as adjunct therapy for older persons with AML.
Chicago VA Healthcare System/Lakeside Division, Midwest Center for Health Services and Policy Research, Illinois 60611, USA. cbenne@northwestern.edu
Charles L
CL
Bennett
Glen T
GT
Schumock
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D017024:Chemotherapy, Adjuvant; D003115:Colony-Stimulating Factors / Q000191:economics / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D003657:Decision Making; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000191:economics; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced / Q000188:drug therapy; D016032:Randomized Controlled Trials as Topic
D003115:Colony-Stimulating Factors