title: Pharmacoeconomics of granulocyte colony-stimulating factor: a critical review.
abstract: BACKGROUND
  In the USA, neutropenia-related hospitalization is estimated to occur in 34.2 cases per 1,000 chemotherapy-treated patients. The cost of hospitalization is significant with estimates ranging, on average, from $10,000 to $30,000 per neutropenia-related hospitalization. Prophylactic use of granulocyte colony-stimulating factor (G-CSF) significantly reduces the risk and duration of neutropenia-related negative events. However, the exact economic benefits of using G-CSF prophylactically are not completely known. The objective of this review is to examine the cost of G-CSF as primary prophylaxis (PP) as well as when used reactively to treat severe neutropenia (SN) or febrile neutropenia (FN).
  
  
  METHODS
  Electronic databases were searched for studies published up to January 2014.
  
  
  RESULTS
  The evidence supporting the cost-effectiveness of PP use of G-CSF is inconsistent. The cost savings of PP use of G-CSF associated with the reduction of neutropenia-related events are offset by the increased costs associated with improved chemotherapy administration. Cost savings due to the reduction in mortality and disease/symptoms and use of dose-dense regimens have not been adequately incorporated into previous cost-effectiveness studies. Available data suggest that using G-CSF in conjunction with antibiotics is more cost-effective than antibiotics alone when treating patients with SN/FN. Recent studies of biosimilars suggest that they are as effective as originator G-CSFs and, given their lower cost, could represent a cost-effective alternative. Finally, studies have not taken into consideration the indirect patient costs of experiencing a neutropenia-related event.
  
  
  CONCLUSIONS
  G-CSF use is effective in preventing SN/FN. Costs due to hospitalization and other neutropenia-related events are lower in patients treated with G-CSF as PP versus untreated patients. Despite this, many studies have not found solid evidence for the overall cost-effectiveness of PP use of G-CSF. One possibility for this is that patients receiving G-CSF prophylactically often receive more intense chemotherapy regimens, have better relative dose intensity, and fewer dose delays, and thereby have greater costs associated with chemotherapy administration than patients who do not receive G-CSF.
authors.affiliation: Health Economics and Outcomes Research, Teva Pharmaceuticals, Philadelphia, PA, USA, Gisoo.Barnes@tevapharm.com.
authors.forename: Gisoo
authors.initials: G
authors.lastname: Barnes
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Pathak
authors.forename: Lee
authors.initials: L
authors.lastname: Schwartzberg
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects; D059451:Biosimilar Pharmaceuticals / Q000191:economics / Q000627:therapeutic use; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D004305:Dose-Response Relationship, Drug; D064147:Febrile Neutropenia / Q000188:drug therapy / Q000209:etiology; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D009503:Neutropenia / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control*; D011788:Quality of Life; D012720:Severity of Illness Index
chemical_list: D000970:Antineoplastic Agents; D059451:Biosimilar Pharmaceuticals; D016179:Granulocyte Colony-Stimulating Factor