LONG BEACH, Calif--There is no controversy in medical oncology
that G-CSF decreases the risk of infection associated with neutropenia
in patients receiving cytotoxic chemotherapy. But does it save
money? To answer that question, John Glaspy, MD, MPH, and his
colleagues at UCLA School of Medicine used a decision analysis
model to determine the economic impact of G-CSF given as supportive
The economic study was based on data from the licensing trial
for G-CSF (filgrastim, Neupogen). This trial involved patients
with small-cell lung cancer who were randomized to receive the
same chemotherapy regimen with either placebo or G-CSF, with the
incidence of febrile neutropenia as the end point.
$2,302 Per Patient Per Cycle
The researchers collected hospital bills from patients in the
study at three sites--UCLA, Duke, and Pittsburgh. To calculate
drug cost, the mean duration of G-CSF therapy was multiplied by
the average wholesale price of the agent at that time, weighted
for the size of the patient, since G-CSF is prescribed on a per
"We added on some extra money for the cost of doing the extra
blood counts and of buying the needles and syringes, and came
up with a proposed cost for G-CSF therapy of $2,302 per patient
per cycle of chemotherapy administered," Dr. Glaspy said
at the 1995 Quality of Life symposium sponsored by St. Mary Medical
Center, Cancer Care Center.
To determine the cost of an episode of febrile neutropenia requiring
hospitalization, the researchers relied on the Medicare database,
which showed that nationally, these patients stay in the hospital
about 8 days, with hospital charges of around $1,000 a day, for
a total of about $8,000.
The G-CSF patients had fewer hospitalizations on the first cycle
than did the placebo group, and in addition, those admissions
that did occur lasted about half as long, resulting in about a
50% reduction in hospital charges.