title: Reducing Overuse of Colony-Stimulating Factors in Patients With Lung Cancer Receiving Chemotherapy: Evidence From a Decision Support-Enabled Program.
abstract: Colony-stimulating factors (CSFs) are frequently overused for the primary prevention of febrile neutropenia (FN) in patients receiving chemotherapy.
  
  
  
  A retrospective cohort study design was used to analyze commercial claims data in adults with lung cancer initiated on chemotherapy from April 1, 2013, to March 30, 2015. The tool was implemented at oncology practices in phases across 14 US states. Patients were assigned to intervention and nonintervention states according to whether they resided in service areas where the tool had been implemented. Patients were followed up to 6 months after initiating chemotherapy. Difference in pre- and postimplementation CSF use and FN incidence rates were compared with the use of difference-in-differences (DID) models that were adjusted for baseline FN risk factors.
  
  
  
  The study population of 3,467 patients (intervention states: pre, 707; post, 1,150; nonintervention states: pre, 636; post, 974) showed no significant differences in FN risk factors at baseline. In adjusted results before and after implementation, CSF use decreased from 48.4% to 35.6% in the intervention states versus 43.2% to 44.4% in the nonintervention states (DID, -8.7%; 95% CI, -14.65% to -2.67%; P ≤ .001). The rates of FN were consistent for both groups in both periods, with no statistical difference in trend for the intervention (2.8% to 4.3%) versus the nonintervention (3.1% to 5.1%) states (DID, -0.13; 95% CI, -0.35 to 0.10; P = .927).
  
  
  
  These findings demonstrate that a decision support-enabled utilization management tool can improve risk-appropriate, guideline-adherent CSF use in patients with lung cancer.
authors.affiliation: HealthCore, Wilmington, DE; Anthem, Woodland Hills, CA; and AIM Specialty Health, Deerfield, IL.
authors.forename: Gboyega
authors.initials: G
authors.lastname: Adeboyeje
authors.affiliation: HealthCore, Wilmington, DE; Anthem, Woodland Hills, CA; and AIM Specialty Health, Deerfield, IL.
authors.forename: Abiy
authors.initials: A
authors.lastname: Agiro
authors.affiliation: HealthCore, Wilmington, DE; Anthem, Woodland Hills, CA; and AIM Specialty Health, Deerfield, IL.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Malin
authors.affiliation: HealthCore, Wilmington, DE; Anthem, Woodland Hills, CA; and AIM Specialty Health, Deerfield, IL.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fisch
authors.affiliation: HealthCore, Wilmington, DE; Anthem, Woodland Hills, CA; and AIM Specialty Health, Deerfield, IL.
authors.forename: Andrea
authors.initials: A
authors.lastname: DeVries
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D003115:Colony-Stimulating Factors / Q000008:administration & dosage / Q000627:therapeutic use*; D020000:Decision Support Systems, Clinical; D019468:Disease Management; D064147:Febrile Neutropenia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006760:Hospitalization; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D000067490:Prescription Drug Overuse / Q000706:statistics & numerical data*; D062486:Public Health Surveillance; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D003115:Colony-Stimulating Factors