We reviewed the outcome of 24 patients with early and advanced stage Hodgkin lymphoma (HL) treated with ABVD chemotherapy (263 treatment deliveries) without the use of G-CSF over a 3-year period. Patients received full dose ABVD regardless of the absolute neutrophil count (ANC) on the day of treatment if there were no other cytopenias or toxicities. Forty-eight percent of treatment deliveries were given with an ANC <1.0 x 10(9)/L and 18% with an ANC <0.5 x 10(9)/L. Four patients required drug omissions (vinblastine or bleomycin) due to non-hematological side-effects. The rate of neutropenic sepsis was 0.76%. At a median follow up of 17.5 months, one patient had progressive disease requiring intensive treatment and the remainder were in remission post-treatment. Overall survival and event-free survival were 95.8% and 91.7%, respectively. We estimate a saving of 60,000 pounds in pharmaceutical and nursing expenditure related to G-CSF; a saving of 2000 pounds per patient. We conclude that full dose ABVD can be administered to patients with early and advanced stage HL irrespective of isolated neutropenia on the planned treatment day without prophylactic G-CSF or antibiotics and that this practise is safe, efficacious and cost-saving.

Objectives: The two most common breast reduction techniques presently used in North America are the Vertical Scar Reduction (VSR) and the Inverted T-shaped Reduction (ITR). A previous Randomized Controlled Trial (RCT) has shown no clear superiority of one over the other in terms of Health-Related Quality of Life (HRQL). No economic evaluation has been undertaken however to determine if the VSR is more cost-effective than the ITR. MethOds: 255 patients were randomized to either VSR or ITR immediately pre-operatively. The effectiveness of two techniques was measured with the HUI3. Both direct and productivity costs were captured parallel to the RCT. Case Report Forms (CRF) captured patient-related costs associated with the surgery. The human capital method was used to capture productivity losses. The perspectives of the Ministry of Health (MOH), the patient and the Society were considered Results: ITR dominated VSR under the MOH perspective by being slightly less costly ($3,090.06 vs. $3,106.58) and slightly more effective i.e. 0.87 Quality Adjusted Life Years (QALY) versus 0.86 QALYs. In the societal and patient perspective, VSR was both less costly and less effective. At the commonly quoted Canadian threshold of $50,000 per QALY gained, the probability that VSR was costeffective was 29.3%, 68.2% and 66.9% under a MOH, patient and societal perspective respectively. A subgroup analysis of breast reductions of < 500 grams found that the VSR was more likely cost-effective. cOnclusiOns: This analysis informs us that the VSR is more likely than not, cost-effective from the patient and societal perspective but not from the MOH at a willingness-to-pay threshold of $50,000/ QALY. If, however, we were to limit the VSR for those breast reductions in which we expect excision of breast tissue < 500 grams per breast, then this technique is more likely cost-effective under all perspectives.