PCN15 AN ANALYSIS OF GRANULOCYTE-COLONY STIMULATION FACTOR UTILIZATION FOR THE PREVENTION OF CHEMOTHERAPY-INDUCED FEBRILE NEUTROPENIA AMONG BREAST CANCER PATIENTS IN THE UNITED STATES

Abstract

Clinical trials have shown that granulocyte colony-stimulating factors (GCSF) prophylaxis significantly reduced the risk of febrile neutropenia (FN) in oncology patients receiving myelosuppressive chemotherapies. This study documents the factors associated with the use of GCSF prophylaxis in breast cancer patients and estimates the impact of GCSF prophylaxis on the risks of FN, other infections, hospitalization, and death. A commercial de-identified, HIPPA compliant paid claims dataset covering January 2007 to September 2016 is used for this analysis. Diagnosis codes were used to identify breast cancer patients and document the occurrence of FN. HCPCS codes were used to locate chemotherapy and GCSF claims. The analysis includes only newly diagnosed breast cancer patients with 180-day continuous insurance enrollment prior to the start of chemotherapy. A logistic regression model is used to estimate the association between patient/chemotherapy characteristics and the use of GCSF prophylaxis. A Cox-regression model is then implemented to test the association between GCSF prophylaxis controlling for the concomitant use of antibiotics, chemotherapy FN risk classification, and other patient characteristics. Sensitivity analyses are carried out to test different model specification. Patients using GCSF prophylaxis are less likely to experience FN (HR=0.24, P <0.01) and death within 60 days of chemotherapy (HR=0.22, P<0.01) during their first session of chemotherapy treatment compared to the non-GCSF prophylaxis cohort. GCSF effects are especially significant among patients using high-risk chemotherapy regimens (HR=0.19, P <0.01). No significant association is found between the timing of prophylaxis onset and its effectiveness reducing FN risk. GCSF prophylaxis had no significant effect on infection-related hospitalizations. GCSF prophylaxis effectively prevents FN events in the 1st treatment session of myelosuppressive chemotherapy among breast cancer patients. Patients using high-FN risk chemotherapy regimens benefit from GCSF prophylaxis the most. Patients using intermediate and low FN risk chemotherapy regimens also received insignificant benefit from GCSF prophylaxis.