Therapeutic use of granulocyte colony-stimulating factors for established febrile neutropenia: effect on costs from a hospital perspective.
BACKGROUND
The prophylactic use of granulocyte colony-stimulating factors (G-CSFs) reduces the severity and duration of neutropenia and reduces the incidence of febrile neutropenia after cancer chemotherapy. However, the use of G-CSFs, particularly filgrastim, to treat established neutropenia remains controversial. A recent meta-analysis of randomised controlled trials (RCTs) evaluating G-CSF treatment for established febrile neutropenia demonstrated a reduction in prolonged hospitalisations. Because more than one-third of patients in the analysis were hospitalised for at least 10 days, this finding has broad pharmacoeconomic and clinical significance. This analysis presents the potential cost implications of G-CSF treatment for established neutropenia among hospitalised patients.


METHODS
Direct medical costs ($US, year 2003 values) related to hospitalisation for established neutropenia were modelled using a hospital perspective and according to two treatment options: (i) no use of G-CSF during the neutropenic episode (control); and (ii) addition of daily G-CSF until neutrophil recovery. Within each option, we modelled the probability of a long stay (>or=10 days) and patient survival. The model used three data sets: discharge data from a consortium of academic medical institutions, drug cost data (filgrastim) from Federal payers, and estimates of G-CSF efficacy derived from a meta-analysis of RCTs of treatment in patients with established febrile neutropenia. The lowest expected total cost was predicted for both treatment options; sensitivity analyses and Monte Carlo simulations were used to evaluate the robustness of the model.


RESULTS
The G-CSF arm produced the lowest expected cost, and predicted net estimated savings of $US1046 per neutropenic episode compared with the control strategy. G-CSF was less expensive than the control for most reasonable estimates of cost per day and all lengths of stay (LOS) >or=10 days. G-CSF was the least costly strategy for 73.5% of 10,000 Monte Carlo iterations, while the no-G-CSF control strategy predicted savings in 26.5% of iterations.


CONCLUSIONS
This pharmacoeconomic model suggests that therapeutic use of G-CSF should be considered for patients with established neutropenia in order to reduce overall hospital cost. G-CSF treatment may offer substantial potential savings for hospitalised patients with established neutropenia over a wide range of model assumptions. Therapeutic G-CSF use among patients hospitalised for established neutropenia may complement the recommended prophylactic use of these agents for the prevention of neutropenic episodes.
Cosler
Leon E
LE
Albany College of Pharmacy, Albany, New York, USA.
Eldar-Lissai
Adi
A
Culakova
Eva
E
Kuderer
Nicole M
NM
Dale
David
D
Crawford
Jeffrey
J
Lyman
Gary H
GH
D003365:Costs and Cost Analysis; D005334:Fever / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D016179:Granulocyte Colony-Stimulating Factor / Q000191:economics / Q000627:therapeutic use*; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D018803:Models, Economic; D009010:Monte Carlo Method; D009503:Neutropenia / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D010351:Patient Discharge / Q000706:statistics & numerical data; D016019:Survival Analysis; D013997:Time Factors
D016179:Granulocyte Colony-Stimulating Factor