Incidence of neutropenic fever in patients treated with standard-dose combination chemotherapy for small-cell lung cancer and the cost impact of treatment with granulocyte colony-stimulating factor

Craig R. Nichols, Edward P. Fox, Bruce J. Roth, Stephen D. Williams, Patrick Loehrer, Lawrence Einhorn

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Abstract

Purpose: We sought to determine the incidence of neutropenic fever associated with the use of standard-dose combination chemotherapy for small- cell lung cancer (SCLC) and to use these data as a template to analyze the costs and benefits of the routine use of granulocyte colony-stimulating factor (G-CSF). Patients and Methods: We retrospectively reviewed records of 137 consecutive, unselected patients with SCLC treated with combination chemotherapy from January 1987 to March 1992. Admission criteria for neutropenic fever were temperature ≥ 38.5°C and an absolute neutrophil count ≤ 500/μL. Neutropenic fevers were managed with a 25% dose reduction of the myelosuppressive drugs in subsequent cycles. Charge estimates for hospitalization ($1,244 per day) and G-CSF use ($2,027 per course) were estimated by reviewing charges to patients at Indiana University hospitalized for neutropenic fever or treated with outpatient G-CSF. We imposed assumptions from the Neupogen (filgrastim; Amgen Inc, Thousand Oaks, CA) licensing trial regarding the effectiveness of G-CSF and the Indiana University charge estimates on three models of G-CSF use: (1) preemptive - with all courses of chemotherapy, (2) reactive - with all cycles of chemotherapy following a neutropenic fever, and (3) dose reduction only (no G-CSF) - to derive charge estimates for G-CSF use. Results: Records of 137 patients with SCLC were identified and reviewed. The incidence of neutropenic fever was 12% in the first cycle of chemotherapy, and 18% overall, compared with the placebo- and G-CSF-treated arms of the Neupogen licensing trial, in which the incidence of neutropenic fever was 77% and 40%, respectively. Other therapeutic outcomes, such as neutropenic septic deaths, response rates, and survival, were comparable. We derived the following charge estimates for the three models of G-CSF: (1) preemptive - total charges = $1,287,481; (2) reactive - total charges = $276,154; and (3) dose reduction only - total charges = $192,820. Conclusion: The incidence of neutropenic fever with standard-dose chemotherapy for SCLC was 18%. Routine use of G-CSF in SCLC patients treated with standard-dose chemotherapy appears to be expensive and is not associated with an obvious therapeutic benefit or cost savings. We suggest that careful analysis of the incidence of infectious complications, rather than granulocyte nadir and duration, be performed, and that clinical guidelines for the use of these effective, but expensive, products be developed.

Original languageEnglish
Pages (from-to)1245-1250
Number of pages6
JournalJournal of Clinical Oncology
Volume12
Issue number6
StatePublished - Jun 1994

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Small Cell Lung Carcinoma
Granulocyte Colony-Stimulating Factor
Combination Drug Therapy
Health Care Costs
Fever
Incidence
Drug Therapy
Macrophage Colony-Stimulating Factor
Licensure
Cost-Benefit Analysis
Cost Savings
Granulocyte-Macrophage Colony-Stimulating Factor
Granulocytes
Hospitalization
Neutrophils
Outpatients
Placebos
Guidelines
Temperature
Survival

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

@article{4bb9109bfa764768b95845d6f1bc960b,
title = "Incidence of neutropenic fever in patients treated with standard-dose combination chemotherapy for small-cell lung cancer and the cost impact of treatment with granulocyte colony-stimulating factor",
abstract = "Purpose: We sought to determine the incidence of neutropenic fever associated with the use of standard-dose combination chemotherapy for small- cell lung cancer (SCLC) and to use these data as a template to analyze the costs and benefits of the routine use of granulocyte colony-stimulating factor (G-CSF). Patients and Methods: We retrospectively reviewed records of 137 consecutive, unselected patients with SCLC treated with combination chemotherapy from January 1987 to March 1992. Admission criteria for neutropenic fever were temperature ≥ 38.5°C and an absolute neutrophil count ≤ 500/μL. Neutropenic fevers were managed with a 25{\%} dose reduction of the myelosuppressive drugs in subsequent cycles. Charge estimates for hospitalization ($1,244 per day) and G-CSF use ($2,027 per course) were estimated by reviewing charges to patients at Indiana University hospitalized for neutropenic fever or treated with outpatient G-CSF. We imposed assumptions from the Neupogen (filgrastim; Amgen Inc, Thousand Oaks, CA) licensing trial regarding the effectiveness of G-CSF and the Indiana University charge estimates on three models of G-CSF use: (1) preemptive - with all courses of chemotherapy, (2) reactive - with all cycles of chemotherapy following a neutropenic fever, and (3) dose reduction only (no G-CSF) - to derive charge estimates for G-CSF use. Results: Records of 137 patients with SCLC were identified and reviewed. The incidence of neutropenic fever was 12{\%} in the first cycle of chemotherapy, and 18{\%} overall, compared with the placebo- and G-CSF-treated arms of the Neupogen licensing trial, in which the incidence of neutropenic fever was 77{\%} and 40{\%}, respectively. Other therapeutic outcomes, such as neutropenic septic deaths, response rates, and survival, were comparable. We derived the following charge estimates for the three models of G-CSF: (1) preemptive - total charges = $1,287,481; (2) reactive - total charges = $276,154; and (3) dose reduction only - total charges = $192,820. Conclusion: The incidence of neutropenic fever with standard-dose chemotherapy for SCLC was 18{\%}. Routine use of G-CSF in SCLC patients treated with standard-dose chemotherapy appears to be expensive and is not associated with an obvious therapeutic benefit or cost savings. We suggest that careful analysis of the incidence of infectious complications, rather than granulocyte nadir and duration, be performed, and that clinical guidelines for the use of these effective, but expensive, products be developed.",
author = "Nichols, {Craig R.} and Fox, {Edward P.} and Roth, {Bruce J.} and Williams, {Stephen D.} and Patrick Loehrer and Lawrence Einhorn",
year = "1994",
month = "6",
language = "English",
volume = "12",
pages = "1245--1250",
journal = "Journal of Clinical Oncology",
issn = "0732-183X",
publisher = "American Society of Clinical Oncology",
number = "6",

}

TY - JOUR

T1 - Incidence of neutropenic fever in patients treated with standard-dose combination chemotherapy for small-cell lung cancer and the cost impact of treatment with granulocyte colony-stimulating factor

AU - Nichols, Craig R.

AU - Fox, Edward P.

AU - Roth, Bruce J.

AU - Williams, Stephen D.

AU - Loehrer, Patrick

AU - Einhorn, Lawrence

PY - 1994/6

Y1 - 1994/6

N2 - Purpose: We sought to determine the incidence of neutropenic fever associated with the use of standard-dose combination chemotherapy for small- cell lung cancer (SCLC) and to use these data as a template to analyze the costs and benefits of the routine use of granulocyte colony-stimulating factor (G-CSF). Patients and Methods: We retrospectively reviewed records of 137 consecutive, unselected patients with SCLC treated with combination chemotherapy from January 1987 to March 1992. Admission criteria for neutropenic fever were temperature ≥ 38.5°C and an absolute neutrophil count ≤ 500/μL. Neutropenic fevers were managed with a 25% dose reduction of the myelosuppressive drugs in subsequent cycles. Charge estimates for hospitalization ($1,244 per day) and G-CSF use ($2,027 per course) were estimated by reviewing charges to patients at Indiana University hospitalized for neutropenic fever or treated with outpatient G-CSF. We imposed assumptions from the Neupogen (filgrastim; Amgen Inc, Thousand Oaks, CA) licensing trial regarding the effectiveness of G-CSF and the Indiana University charge estimates on three models of G-CSF use: (1) preemptive - with all courses of chemotherapy, (2) reactive - with all cycles of chemotherapy following a neutropenic fever, and (3) dose reduction only (no G-CSF) - to derive charge estimates for G-CSF use. Results: Records of 137 patients with SCLC were identified and reviewed. The incidence of neutropenic fever was 12% in the first cycle of chemotherapy, and 18% overall, compared with the placebo- and G-CSF-treated arms of the Neupogen licensing trial, in which the incidence of neutropenic fever was 77% and 40%, respectively. Other therapeutic outcomes, such as neutropenic septic deaths, response rates, and survival, were comparable. We derived the following charge estimates for the three models of G-CSF: (1) preemptive - total charges = $1,287,481; (2) reactive - total charges = $276,154; and (3) dose reduction only - total charges = $192,820. Conclusion: The incidence of neutropenic fever with standard-dose chemotherapy for SCLC was 18%. Routine use of G-CSF in SCLC patients treated with standard-dose chemotherapy appears to be expensive and is not associated with an obvious therapeutic benefit or cost savings. We suggest that careful analysis of the incidence of infectious complications, rather than granulocyte nadir and duration, be performed, and that clinical guidelines for the use of these effective, but expensive, products be developed.

AB - Purpose: We sought to determine the incidence of neutropenic fever associated with the use of standard-dose combination chemotherapy for small- cell lung cancer (SCLC) and to use these data as a template to analyze the costs and benefits of the routine use of granulocyte colony-stimulating factor (G-CSF). Patients and Methods: We retrospectively reviewed records of 137 consecutive, unselected patients with SCLC treated with combination chemotherapy from January 1987 to March 1992. Admission criteria for neutropenic fever were temperature ≥ 38.5°C and an absolute neutrophil count ≤ 500/μL. Neutropenic fevers were managed with a 25% dose reduction of the myelosuppressive drugs in subsequent cycles. Charge estimates for hospitalization ($1,244 per day) and G-CSF use ($2,027 per course) were estimated by reviewing charges to patients at Indiana University hospitalized for neutropenic fever or treated with outpatient G-CSF. We imposed assumptions from the Neupogen (filgrastim; Amgen Inc, Thousand Oaks, CA) licensing trial regarding the effectiveness of G-CSF and the Indiana University charge estimates on three models of G-CSF use: (1) preemptive - with all courses of chemotherapy, (2) reactive - with all cycles of chemotherapy following a neutropenic fever, and (3) dose reduction only (no G-CSF) - to derive charge estimates for G-CSF use. Results: Records of 137 patients with SCLC were identified and reviewed. The incidence of neutropenic fever was 12% in the first cycle of chemotherapy, and 18% overall, compared with the placebo- and G-CSF-treated arms of the Neupogen licensing trial, in which the incidence of neutropenic fever was 77% and 40%, respectively. Other therapeutic outcomes, such as neutropenic septic deaths, response rates, and survival, were comparable. We derived the following charge estimates for the three models of G-CSF: (1) preemptive - total charges = $1,287,481; (2) reactive - total charges = $276,154; and (3) dose reduction only - total charges = $192,820. Conclusion: The incidence of neutropenic fever with standard-dose chemotherapy for SCLC was 18%. Routine use of G-CSF in SCLC patients treated with standard-dose chemotherapy appears to be expensive and is not associated with an obvious therapeutic benefit or cost savings. We suggest that careful analysis of the incidence of infectious complications, rather than granulocyte nadir and duration, be performed, and that clinical guidelines for the use of these effective, but expensive, products be developed.

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