Economic evaluation of prophylactic granulocyte colony stimulating factor during chemotherapy in elderly patients with aggressive non-Hodgkin's lymphoma.
OBJECTIVE
Treatment with CHOP chemotherapy in elderly patients with aggressive non-Hodgkin's lymphoma (NHL) is less effective and accompanied by more adverse effects than in younger patients. The prophylactic use of granulocyte colony-stimulating factor (G-CSF) might improve the results, but increases the costs of treatment. We analyzed the costs of therapy and follow-up of patients with NHL treated with CHOP with or without G-CSF prophylaxis.


METHODS
Four hundred and eleven patients were randomized for treatment with CHOP or CHOP+G-CSF. A detailed study of treatment costs from randomization until 3 years of follow-up or death was performed in a subset of 100 out of 389 eligible patients. Because costs during follow-up were independent of the use of G-CSF during treatment, costs of follow-up and second-line treatment were calculated irrespective of the treatment arm.


RESULTS
Total hospital costs for first-line treatment were 12178 [95% CI 10297 - 14059] for CHOP alone and 18356 [95% CI 15807 - 20906] for CHOP + G-CSF. Costs during follow-up showed a wide difference (range 74 - 53925) depending on disease status and choice of treatment in the case of relapse or progression.


CONCLUSIONS
The clinical study showed no difference between the treatment arms in response, overall survival or event-free survival, while the costs were significantly higher in the G-CSF arm. We conclude that the addition of prophylactic G-CSF to CHOP chemotherapy is not cost-effective in these patients.
Doorduijn
Jeanette K
JK
Department of Hematology, Erasmus MC Rotterdam, The Netherlands. J.Doorduijn@erasmusmc.nl <J.Doorduijn@erasmusmc.nl>
Buijt
Ivon
I
van der Holt
Bronno
B
van Agthoven
Michel
M
Sonneveld
Pieter
P
Uyl-de Groot
Carin A
CA
D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003520:Cyclophosphamide / Q000008:administration & dosage; D018450:Disease Progression; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D000069585:Filgrastim; D005500:Follow-Up Studies; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D017721:Hospital Costs; D006801:Humans; D017053:Infection Control / Q000191:economics; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy / Q000191:economics*; D008297:Male; D009426:Netherlands; D009503:Neutropenia / Q000139:chemically induced / Q000517:prevention & control*; D011241:Prednisone / Q000008:administration & dosage; D011994:Recombinant Proteins; D016019:Survival Analysis; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D000069585:Filgrastim; D011241:Prednisone