LONG BEACH, Calif--Using five key indicators of the severity of
illness to determine the cost effectiveness of growth factor use,
researchers from Blue Cross of Western Pennsylvania found an average
cost ratio of about 1:7 for the use of G-CSF (filgrastim, Neupogen)
in stage IV breast cancer patients undergoing high-dose chemotherapy/autologous
bone marrow transplantation.
"For every dollar we spent on G-CSF, we saved $7 on inpatient
care," said Grant Lawless, MD, RPh, corporate medical director
and vice president of medical affairs. Speaking at the 1995 Quality
of Life symposium, sponsored by St. Mary Medical Center, Dr. Lawless
emphasized that "this is the simple kind of study we need
to be doing to prove what we know instinctively to be true as
Rather than looking at actual money spent per patient, Dr. Lawless
measured the consumption of health-care re- sources on a daily
basis, "because that allowed us to take into account that
people are less sick the last few days of treatment and require
less costly care."
Patients in the study who received purged bone marrow with G-CSF
were compared with those who received purged bone marrow without
G-CSF, and those who received nonpurged bone marrow with G-CSF
were compared with those who received nonpurged bone marrow without
The five key indicators for comparison were total length of stay,
days when absolute neutrophile count (ANC) was under 500, days
on growth factor, average days on antibiotics, and total cumulative
Dr. Lawless found that length of hospital stay fell by 20% in
the purged bone marrow group with use of G-CSF, and by 17% in
the nonpurged marrow group when G-CSF was given. The average number
of ANC days less than 500 fell by 23% in the purged marrow group
with use of G-CSF, and by 35% in the nonpurged group with G-CSF.
Finally, by using G-CSF, days of antibiotic use fell by 31% in
the purged marrow group and by 19% in the nonpurged marrow group.
With these findings, Dr. Lawless had no trouble justifying the
use of G-CSF to his company, "and it is now a regularly used
product in our area," he said.