title: Use of colony-stimulating factors with chemotherapy: opportunities for cost savings and improved outcomes.
abstract: Myeloid colony-stimulating factors (CSFs) decrease the risk of febrile neutropenia (FN) from high-risk chemotherapy regimens administered to patients at 20% or greater risk of FN, but little is known about their use in clinical practice. We evaluated CSF use in a multiregional population-based cohort of lung and colorectal cancer patients (N = 1849). Only 17% (95% confidence interval [CI] = 8% to 26%) patients treated with high-risk chemotherapy regimens received CSFs, compared with 18% (95% CI = 16% to 20%) and 10% (95% CI = 8% to 12%) of patients treated with intermediate- (10%-20% risk of FN) and low-risk (<10% risk of FN) chemotherapy regimens, respectively. Using a generalized estimating equation model, we found that enrollment in a health maintenance organization (HMO) was strongly associated with a lower adjusted odds of discretionary CSF use, compared with non-HMO patients (odds ratio = 0.44, 95% CI = 0.32 to 0.60, P < .001). All statistical tests were two-sided. Overall, 96% (95% CI = 93% to 98%) of CSFs were administered in scenarios where CSF therapy is not recommended by evidence-based guidelines. This finding suggests that policies to decrease CSF use in patients at lower or intermediate risk of FN may yield substantial cost savings without compromising patient outcomes.
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven St NW, Ste 4100, Washington, DC 20007, USA. alp49@georgetown.edu
authors.forename: Arnold L
authors.initials: AL
authors.lastname: Potosky
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Malin
authors.forename: Benjamin
authors.initials: B
authors.lastname: Kim
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Chrischilles
authors.forename: Solomon B
authors.initials: SB
authors.lastname: Makgoeng
authors.forename: Nadia
authors.initials: N
authors.lastname: Howlader
authors.forename: Jane C
authors.initials: JC
authors.lastname: Weeks
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D015331:Cohort Studies; D003115:Colony-Stimulating Factors / Q000008:administration & dosage* / Q000191:economics*; D015179:Colorectal Neoplasms / Q000188:drug therapy; D017046:Cost Savings; D011307:Drug Prescriptions / Q000191:economics* / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D005260:Female; D005334:Fever / Q000209:etiology / Q000517:prevention & control; D006279:Health Maintenance Organizations; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced / Q000150:complications / Q000517:prevention & control*; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D000970:Antineoplastic Agents; D003115:Colony-Stimulating Factors