Costs of human resources in delivering cancer chemotherapy and managing chemotherapy-induced neutropenia in community practice

Fortner, Barry; Okon, Theodore A.; Zhu, Liling; Tauer, Kurt W.; Moore, Kelley; Templeton, Davis; Schwartzberg, Lee

doi:10.1016/s1548-5315(11)70766-5

Cited by 14 publications

(5 citation statements)

References 17 publications

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“…Comparative studies assessing cost and resource utilization of filgrastim and pegfilgrastim in the United States are limited. A retrospective single-time-point survey conducted by Fortner et al assessed the human resource costs required for administering filgrastim or pegfilgrastim [28]. They concluded that a single administration with filgrastim or pegfilgrastim had equivalent human resource costs, but because of the greater number of visits required with filgrastim, the total time and human resource cost with filgrastim (14.8 hours and $364.66) in a 21-day chemotherapy cycle were more than those with pegfilgrastim (2.4 hours and $57.30).…”

Section: Discussionmentioning

confidence: 99%

Pegfilgrastim prophylaxis is associated with a lower risk of hospitalization of cancer patients than filgrastim prophylaxis: a retrospective United States claims analysis of granulocyte colony-stimulating factors (G-CSF)

et al. 2013

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BackgroundMyelosuppressive chemotherapy can lead to dose-limiting febrile neutropenia. Prophylactic use of recombinant human G-CSF such as daily filgrastim and once-per-cycle pegfilgrastim may reduce the incidence of febrile neutropenia. This comparative study examined the effect of pegfilgrastim versus daily filgrastim on the risk of hospitalization.MethodsThis retrospective United States claims analysis utilized 2004–2009 data for filgrastim- and pegfilgrastim-treated patients receiving chemotherapy for non-Hodgkin’s lymphoma (NHL) or breast, lung, ovarian, or colorectal cancers. Cycles in which pegfilgrastim or filgrastim was administered within 5 days from initiation of chemotherapy (considered to represent prophylaxis) were pooled for analysis. Neutropenia-related hospitalization and other healthcare encounters were defined with a “narrow” criterion for claims with an ICD-9 code for neutropenia and with a “broad” criterion for claims with an ICD-9 code for neutropenia, fever, or infection. Odds ratios (OR) for hospitalization and 95% confidence intervals (CI) were estimated by generalized estimating equation (GEE) models and adjusted for patient, tumor, and treatment characteristics. Per-cycle healthcare utilization and costs were examined for cycles with pegfilgrastim or filgrastim prophylaxis.ResultsWe identified 3,535 patients receiving G-CSF prophylaxis, representing 12,056 chemotherapy cycles (11,683 pegfilgrastim, 373 filgrastim). The mean duration of filgrastim prophylaxis in the sample was 4.8 days. The mean duration of pegfilgrastim prophylaxis in the sample was 1.0 day, consistent with the recommended dosage of pegfilgrastim - a single injection once per chemotherapy cycle. Cycles with prophylactic pegfilgrastim were associated with a decreased risk of neutropenia-related hospitalization (narrow definition: OR = 0.43, 95% CI: 0.16–1.13; broad definition: OR = 0.38, 95% CI: 0.24–0.59) and all-cause hospitalization (OR = 0.50, 95% CI: 0.35–0.72) versus cycles with prophylactic filgrastim. For neutropenia-related utilization by setting of care, there were more ambulatory visits and hospitalizations per cycle associated with filgrastim prophylaxis than with pegfilgrastim prophylaxis. Mean per-cycle neutropenia-related costs were also higher with prophylactic filgrastim than with prophylactic pegfilgrastim.ConclusionsIn this comparative effectiveness study, pegfilgrastim prophylaxis was associated with a reduced risk of neutropenia-related or all-cause hospitalization relative to filgrastim prophylaxis.

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Section: Discussionmentioning

confidence: 99%

Pegfilgrastim prophylaxis is associated with a lower risk of hospitalization of cancer patients than filgrastim prophylaxis: a retrospective United States claims analysis of granulocyte colony-stimulating factors (G-CSF)

et al. 2013

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“…Probabilities including incidence of FN, hospitalization for FN, mortality, and RRR of filgrastim and pegfilgrastim were based on the published literature [4,9,15,21]. Several studies are available describing the use of IV antibiotics in the outpatient setting in terms of both efficacy and duration of treatment [5,20,22,32]. Based on those studies, our base case analysis assumes no FN‐related deaths occur in outpatient settings, because these patients are highly selected low‐risk patients.…”

Section: Methodsmentioning

confidence: 99%

“…Outpatient medical staff costs were based on a study carried out by Fortner et al. [22], in which the researchers measured time and costs for various human resources, including both medical and nonmedical services necessary to manage chemotherapy, chemotherapy‐induced neutropenia, and administration of IV antibiotics in 20 community oncology practices in the United States. Prices of pegfilgrastim (6 mg), filgrastim (300 μg and 480 μg), and IV antibiotics (ceftazidime, 2 g) were obtained from the 2005 Drug Topics Red Book [24], discounted 15% of their average wholesale price to reflect institutional contract prices.…”

Section: Methodsmentioning

confidence: 99%

Economic Analysis of Prophylactic Pegfilgrastim in Adult Cancer Patients Receiving Chemotherapy

Eldar-Lissai

Cosler

Culakova³

et al. 2008

Value in Health

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“…According to a study from 115 medical centers in the United States between 1995 and 2000, the average cost per hospitalization due to FN was reported to be $12,372 for breast cancer [ 3 ]. Another retrospective single-time-point survey study reported that the total time and human resource cost with filgrastim (14.8 hours and $364.66) in a 21-day chemotherapy cycle were higher than those with pegfilgrastim (2.4 hours and $57.30) [ 27 ]. In this study of real-world clinical practice, the total hospital care cost for all chemotherapy treatments was greater for filgrastim than that for pegfilgrastim (USD 3,038 vs. USD 2,347, p < 0.001) because of the greater costs of inpatient care during filgrastim cycles.…”

Section: Discussionmentioning

confidence: 99%

Clinical Impact of Primary Prophylactic Pegfilgrastim in Breast Cancer Patients Receiving Adjuvant Docetaxel-Doxorubicin-Cyclophosphamide Chemotherapy

et al. 2020

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Purpose The regimen including concurrent docetaxel, doxorubicin, and cyclophosphamide (TAC) has been categorized as an important risk factor for febrile neutropenia (FN). This comparative study examined the clinical impact of long-acting granulocyte colony-stimulating factor (G-CSF) (pegfilgrastim) during adjuvant TAC chemotherapy in Korean patients with advanced breast cancer. Methods We analyzed data from 239 patients who received 6 cycles of adjuvant TAC chemotherapy. We categorized patients into 2 groups according to the use of primary prophylactic pegfilgrastim and compared the incidence and risk of FN, hospital care costs, and survival in the 2 groups. Results The incidence of FN decreased from 54.2% to 21.2% in all patients, after the use of pegfilgrastim. The analysis of a total of 1,432 chemotherapy cycles showed that the incidence of FN decreased from 36.1% to 9.1% after the use of pegfilgrastim. Moreover, the decrease in the incidence of FN with the use of pegfilgrastim resulted in a significant decrease in the mean duration of neutropenia (4.15 to 1.29 days), the risk of hospitalization (99.5% to 29.7%) and the mean total hospital care cost (USD 3,038 to USD 2,347). High relative dose intensity (RDI) in patients treated with pegfilgrastim than in those not treated with pegfilgrastim (99.18% vs. 93.85%) was associated with a better overall survival ( p = 0.033). Conclusions The use of pegfilgrastim during adjuvant TAC chemotherapy was significantly associated with a decrease in the incidence and risk of FN, hospital care costs, and risk of death compared to the use of adjuvant TAC without primary prophylaxis.

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Costs of human resources in delivering cancer chemotherapy and managing chemotherapy-induced neutropenia in community practice

Cited by 14 publications

References 17 publications

Pegfilgrastim prophylaxis is associated with a lower risk of hospitalization of cancer patients than filgrastim prophylaxis: a retrospective United States claims analysis of granulocyte colony-stimulating factors (G-CSF)

Pegfilgrastim prophylaxis is associated with a lower risk of hospitalization of cancer patients than filgrastim prophylaxis: a retrospective United States claims analysis of granulocyte colony-stimulating factors (G-CSF)

Economic Analysis of Prophylactic Pegfilgrastim in Adult Cancer Patients Receiving Chemotherapy

Clinical Impact of Primary Prophylactic Pegfilgrastim in Breast Cancer Patients Receiving Adjuvant Docetaxel-Doxorubicin-Cyclophosphamide Chemotherapy

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