CHICAGOA cost analysis of the use of G-CSF (Neupogen) in
elderly patients undergoing intensive chemotherapy for acute
myelogenous leukemia (AML) showed the agent to be almost cost
neutral, Tammy J. Stinson, MS, said at a poster session of the
American Society of Hematology annual meeting.
Although G-CSF use reduced the need for IV antibiotics in this study,
the savings did not quite offset the costs of the agent.
Ms. Stinson, project manager and research analyst at VA Chicago
Healthcare Systems-Lakeside, reported the results for her colleagues
from Northwestern University, Loyola University, and Lakeside and
Hines VA Medical Centers, and the Fred Hutchinson Cancer Research
Phase III Trial Data Used
Clinical data for the analysis were based on phase III trial
information from 207 AML patients, age 56 and older, who were
randomly assigned to one of two intensive remission induction
treatment arms: cytarabine and daunorubicin (Cerubidine) plus
placebo, or cytarabine and daunorubicin plus G-CSF.
Cost estimates were based on detailed financial accounts of charges
for older patients treated in a similar, previously published AML
trial. A decision analysis model was used, with development of
serious infection after induction therapy as the key clinical outcome.
Daily Cost Analysis
Daily cost estimates were developed for two eventualities: treatment
of an infection that required IV antibiotic therapy ($1,840/day) and
time without an infection ($1,370/day). The higher daily cost for
treatment of an infection reflected the additional use of
antibiotics, laboratory tests, radiographs, cultures, and nursing and
professional time, she said.
Total costs in each arm of the study were estimated by adding median
days on IV antibiotics (multiplied by $1,840) and median days not on
IV antibiotics (multiplied by $1,370). Cost profiles of patients in
the G-CSF arm included the additional cost of the G-CSF ($200/day).
Clinical outcomes had been reported previously (Godwin et al: Blood
9:3607-3615, 1998). No significant differences were found between the
two arms, Ms. Stinson said, including complete response rate;
survival; median number of days of hospitalization; and percent of
patients with culture-confirmed infections, fungal infections,
pneumonia, positive blood cultures, or fatal infections.
However, Ms. Stinson pointed out, among the G-CSF recipients, there
was a significant reduction in the duration of neutropenia (24 vs 27
days, P = .014) and days with an active infection requiring IV
antibiotics (22 vs 26, P < .053).
Despite the fact that there was somewhat lessening of
neutropenia in the G-CSF arm, the costs are essentially equivalent in
each arm, Ms. Stinson said.
Estimated Overall Costs
Estimated overall costs were $51,950 for the placebo group and
$52,070 for the G-CSF group. Therefore, the estimated $1,880 savings
that might have resulted from the use of G-CSF was offset by the cost
of the drug ($2,000 for 10 days of G-CSF).
The investigators estimates were sensitive to the number of
days with an active infection and the cost per hospitalized day.
Sensitivity analyses revealed that the difference in the number of
days with an active infection requiring IV antibiotics would need to
be more than 6 days to be cost saving for G-CSF use. Alternatively, a
break-even analysis indicated that G-CSF use would be cost neutral at
a daily cost of $188.
Whether or not to use G-CSF in this subset of patients is best
left to clinical judgment, Ms. Stinson concluded.
Its unlikely that your overall costs will be higher or
lower with G-CSF, based on these trial results.