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 care.
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 kilogram basis.
"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.