Economic evaluations of granulocyte colony-stimulating factor: in the prevention and treatment of chemotherapy-induced neutropenia.
The prevailing uncertainty about the pharmacoeconomic positioning of granulocyte colony-stimulating factor (G-CSF) in the prevention and treatment of chemotherapy-induced febrile neutropenia has resulted in a number of pharmacoeconomic evaluations published in the past 10 years. These studies vary considerably regarding the approaches used and the results presented. In order to contribute to a clearer pharmacoeconomic positioning of G-CSF, a systematic review of economic evaluations was carried out. The focus of the review was prophylaxis and therapy of chemotherapy-induced neutropenia in patients with cancer. A computerised bibliography search of several databases was conducted yielding 33 studies. The findings demonstrated the cost-saving potential of G-CSF in standard-dose chemotherapy to be limited, with lower costs often seen in the control group. The results of these studies were too heterogeneous to extract a clear recommendation from a cost-saving point of view. The administration of G-CSF after high-dose chemotherapy with stem cell support resulted more often in cost savings in the G-CSF group as compared with standard-dose chemotherapy, illustrating a possible cost-saving potential of G-CSF. In the treatment of established chemotherapy-induced febrile neutropenia, cost savings were found in all studies. This result is surprising but hampered by the small number of studies (n = 5) and remains to be confirmed by more rigourously designed prospective economic analyses. Despite the substantial research on this topic, the economic evaluation of G-CSF is far from being settled and needs further investigation.
Esser
Marc
M
Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany. Marc.Esser@Schering.de
Brunner
Helmut
H
D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D016179:Granulocyte Colony-Stimulating Factor / Q000191:economics* / Q000627:therapeutic use*; D006801:Humans; D009369:Neoplasms / Q000628:therapy; D009503:Neutropenia / Q000139:chemically induced / Q000188:drug therapy* / Q000191:economics* / Q000517:prevention & control; D012189:Retrospective Studies; D033581:Stem Cell Transplantation
D000970:Antineoplastic Agents; D016179:Granulocyte Colony-Stimulating Factor