title: Cost-effectiveness of white blood cell growth factor use among a large nationwide cohort of elderly non-Hodgkin's lymphoma patients treated with chemotherapy.
abstract: OBJECTIVE
  To determine the cost-effectiveness (as measured as cost per life-year saved) of white blood cell growth factor or colony-stimulating factor (CSF) use among a large cohort of elderly non-Hodgkin's lymphoma (NHL) patients in a real-world setting.
  
  
  METHODS
  We identified 13,203 NHL patients from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database who received the diagnosis from 1992 to 2002 and who received chemotherapy within 12 months of diagnosis. Benefit (effectiveness) of CSF use (primary and secondary prophylaxis) was measured as observed improvement in overall survival. Costs for each patient were calculated by adding the cumulative reimbursement amounts from Medicare claims. Cost-effectiveness was estimated by modeling the joint influence of CSF use on both costs and effectiveness using a propensity-score net monetary benefit approach.
  
  
  RESULTS
  Primary prophylactic CSF use was cost-effective at lower willingness-to-pay thresholds, whereas at higher thresholds, not providing prophylactic CSF became the cost-effective strategy. For secondary prophylactic CSF use among patients experiencing neutropenia, fever, and/or infection, the opposite trend was observed. For low willingness-to-pay thresholds (<$20,000 per life-year gained), not administering CSF was the cost-effective strategy, whereas CSF use became cost-effective as willingness to pay increased (from $100,000+ per life-year gained).
  
  
  CONCLUSIONS
  To our knowledge, this is the first large population-based study to empirically measure the cost-effectiveness of CSF among NHL patients treated with chemotherapy. CSF use as primary or secondary prophylaxis may be a cost-effective strategy depending on society's (or payers') willingness to pay for improvements in outcomes.
authors.affiliation: Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston, TX 77030, USA.
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Gruschkus
authors.forename: David
authors.initials: D
authors.lastname: Lairson
authors.forename: J Kay
authors.initials: JK
authors.lastname: Dunn
authors.forename: Jan
authors.initials: J
authors.lastname: Risser
authors.forename: Xianglin L
authors.initials: XL
authors.lastname: Du
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000191:economics / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000191:economics / Q000627:therapeutic use; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D007345:Insurance Claim Review; D008228:Lymphoma, Non-Hodgkin / Q000097:blood* / Q000188:drug therapy* / Q000191:economics; D008297:Male; D006278:Medicare / Q000191:economics; D009503:Neutropenia / Q000139:chemically induced / Q000191:economics / Q000517:prevention & control*; D018426:SEER Program; D016019:Survival Analysis; D014481:United States
chemical_list: D000970:Antineoplastic Agents; D016179:Granulocyte Colony-Stimulating Factor