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Therapeutic use of granulocyte colony-stimulating factors for established febrile neutropenia: effect on costs from a hospital perspective.

Publication ,  Journal Article
Cosler, LE; Eldar-Lissai, A; Culakova, E; Kuderer, NM; Dale, D; Crawford, J; Lyman, GH
Published in: Pharmacoeconomics
2007

BACKGROUND: The prophylactic use of granulocyte colony-stimulating factors (G-CSFs) reduces the severity and duration of neutropenia and reduces the incidence of febrile neutropenia after cancer chemotherapy. However, the use of G-CSFs, particularly filgrastim, to treat established neutropenia remains controversial. A recent meta-analysis of randomised controlled trials (RCTs) evaluating G-CSF treatment for established febrile neutropenia demonstrated a reduction in prolonged hospitalisations. Because more than one-third of patients in the analysis were hospitalised for at least 10 days, this finding has broad pharmacoeconomic and clinical significance. This analysis presents the potential cost implications of G-CSF treatment for established neutropenia among hospitalised patients. METHODS: Direct medical costs ($US, year 2003 values) related to hospitalisation for established neutropenia were modelled using a hospital perspective and according to two treatment options: (i) no use of G-CSF during the neutropenic episode (control); and (ii) addition of daily G-CSF until neutrophil recovery. Within each option, we modelled the probability of a long stay (>or=10 days) and patient survival. The model used three data sets: discharge data from a consortium of academic medical institutions, drug cost data (filgrastim) from Federal payers, and estimates of G-CSF efficacy derived from a meta-analysis of RCTs of treatment in patients with established febrile neutropenia. The lowest expected total cost was predicted for both treatment options; sensitivity analyses and Monte Carlo simulations were used to evaluate the robustness of the model. RESULTS: The G-CSF arm produced the lowest expected cost, and predicted net estimated savings of $US1046 per neutropenic episode compared with the control strategy. G-CSF was less expensive than the control for most reasonable estimates of cost per day and all lengths of stay (LOS) >or=10 days. G-CSF was the least costly strategy for 73.5% of 10,000 Monte Carlo iterations, while the no-G-CSF control strategy predicted savings in 26.5% of iterations. CONCLUSIONS: This pharmacoeconomic model suggests that therapeutic use of G-CSF should be considered for patients with established neutropenia in order to reduce overall hospital cost. G-CSF treatment may offer substantial potential savings for hospitalised patients with established neutropenia over a wide range of model assumptions. Therapeutic G-CSF use among patients hospitalised for established neutropenia may complement the recommended prophylactic use of these agents for the prevention of neutropenic episodes.

Duke Scholars

Published In

Pharmacoeconomics

DOI

ISSN

1170-7690

Publication Date

2007

Volume

25

Issue

4

Start / End Page

343 / 351

Location

New Zealand

Related Subject Headings

  • Time Factors
  • Survival Analysis
  • Patient Discharge
  • Neutropenia
  • Monte Carlo Method
  • Models, Economic
  • Length of Stay
  • Humans
  • Hospitalization
  • Hospital Mortality
 

Citation

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MLA
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Cosler, L. E., Eldar-Lissai, A., Culakova, E., Kuderer, N. M., Dale, D., Crawford, J., & Lyman, G. H. (2007). Therapeutic use of granulocyte colony-stimulating factors for established febrile neutropenia: effect on costs from a hospital perspective. Pharmacoeconomics, 25(4), 343–351. https://doi.org/10.2165/00019053-200725040-00006
Cosler, Leon E., Adi Eldar-Lissai, Eva Culakova, Nicole M. Kuderer, David Dale, Jeffrey Crawford, and Gary H. Lyman. “Therapeutic use of granulocyte colony-stimulating factors for established febrile neutropenia: effect on costs from a hospital perspective.Pharmacoeconomics 25, no. 4 (2007): 343–51. https://doi.org/10.2165/00019053-200725040-00006.
Cosler LE, Eldar-Lissai A, Culakova E, Kuderer NM, Dale D, Crawford J, et al. Therapeutic use of granulocyte colony-stimulating factors for established febrile neutropenia: effect on costs from a hospital perspective. Pharmacoeconomics. 2007;25(4):343–51.
Cosler, Leon E., et al. “Therapeutic use of granulocyte colony-stimulating factors for established febrile neutropenia: effect on costs from a hospital perspective.Pharmacoeconomics, vol. 25, no. 4, 2007, pp. 343–51. Pubmed, doi:10.2165/00019053-200725040-00006.
Cosler LE, Eldar-Lissai A, Culakova E, Kuderer NM, Dale D, Crawford J, Lyman GH. Therapeutic use of granulocyte colony-stimulating factors for established febrile neutropenia: effect on costs from a hospital perspective. Pharmacoeconomics. 2007;25(4):343–351.
Journal cover image

Published In

Pharmacoeconomics

DOI

ISSN

1170-7690

Publication Date

2007

Volume

25

Issue

4

Start / End Page

343 / 351

Location

New Zealand

Related Subject Headings

  • Time Factors
  • Survival Analysis
  • Patient Discharge
  • Neutropenia
  • Monte Carlo Method
  • Models, Economic
  • Length of Stay
  • Humans
  • Hospitalization
  • Hospital Mortality