A clinical and economic drug usage evaluation of prophylactic G-CSF in non-Hodgkin's lymphoma

Abstract

Objective. To identify if prophylactic granulocyte colony-stimulating factor (G-CSF) delivers the same clinical outcome and level of cost-effectiveness in general clinical use as it has under controlled clinical trial conditions in patients with non-Hodgkin's lym phoma. Method. A 6-month prospective study of all patients eligible to receive prophylactic G-CSF for supportive treatment for non-Hodgkin's lymphoma was performed. Outcomes measured included occur rence of febrile neutropenia, length of hospital stay, and cost of admission. The critical values of key pharmacoeconomic parameters were calculated for this patient group and compared with the actual values obtained. Results. The use of G-CSF in all 99 courses, for 35 patients, complied with funding guidelines. Pro phylactic G-CSF was prescribed most frequently for chemotherapy courses which were most likely to result in febrile neutropenia. The percentage of che motherapy courses associated with febrile neutrope nia in patients who did not receive G-CSF increased significantly with treatment intensity. Prophylactic G-CSF appeared to be cost-effective for patients re ceiving high intensity chemotherapy but not for other patients. Conclusion. Clinicians at our institute use G- CSF where clinical benefits are most likely to be obtained. The use of prophylactic G-CSF is more cost-effective than using therapeutic G-CSF to treat febrile neutropenia in high risk patients. The contin ued funding of prophylactic G-CSF for non-Hodgkin's lymphoma is justified clinically and economically in patients receiving intensive chemotherapy.