title: Short-term costs associated with primary prophylactic G-CSF use during chemotherapy.
abstract: Chemotherapy is vital for breast cancer treatment, but early-onset toxicities like neutropenia hinder its administration. Neutropenia also increases costs due to hospitalizations and aggressive systemic antibiotic administration. Primary prophylactic (PP) use of granulocyte colony-stimulating factor (G-CSF) helps prevent neutropenia. However, evidence supporting the cost-effectiveness of PPG-CSF is inconclusive, and American Society of Clinical Oncology guidelines state the need for performing cost analyses in high-risk groups like the elderly.
  
  
  
  To examine the effect of PPG-CSF administration on neutropenia hospitalization costs and overall Medicare costs during the year following chemotherapy initiation.
  
  
  
  A retrospective observational study of patients newly diagnosed with breast cancer between 1994 and 2002 was performed using the linked SEER-Medicare database. To account for the nonrandom nature of observational data, a covariate matching technique was used to preprocess the data before performing parametric analysis estimating the effect of PPG-CSF on costs.
  
  
  
  Administration of PPG-CSF during the first course of chemotherapy was associated with a 57% increase in overall Medicare costs during the study period, despite a drop in neutropenia hospitalization costs. Forty-two percent of the increase in costs was due to increase in chemotherapy costs during the year after chemotherapy initiation.
  
  
  
  A significant part of the increase in immediate medical costs in breast cancer patients receiving PPG-CSF is due to improved chemotherapy administration. It is important to determine whether these short-term cost increases lead to long-term health benefits and savings. Cost analyses with longer follow-ups are crucial for chronic diseases like breast cancer.
authors: Management, Policy and Community Health Division, School of Public Health, University of Texas Health Science Center, 1200 Herman Pressler St, Houston, TX 77030, USA. e-mail: suja.s.rajan@uth.tmc.edu
authors: Suja S
authors: SS
authors: Rajan
authors: William R
authors: WR
authors: Carpenter
authors: Sally C
authors: SC
authors: Stearns
authors: Gary H
authors: GH
authors: Lyman
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000191:economics* / Q000627:therapeutic use; D017721:Hospital Costs; D006801:Humans; D009503:Neutropenia / Q000139:chemically induced / Q000188:drug therapy*; D012042:Registries; D012189:Retrospective Studies; D018426:SEER Program; D014481:United States
chemical_list: D016179:Granulocyte Colony-Stimulating Factor