RECOMBINANT GRANULOCYTE-MACROPHAGE COLONY-STIMULATING FACTOR (RGM-CSF) - AN APPRAISAL OF ITS PHARMACOECONOMIC STATUS IN NEUTROPENIA ASSOCIATED WITH CHEMOTHERAPY AND AUTOLOGOUS BONE-MARROW TRANSPLANT

Recombinant granulocyte-macrophage colony-stimulating factor (rGM-CSF) expedites neutrophil recovery in cancer patients receiving chemothera py with or without autologous bone marrow transplant (ABMT). The limit ed cost analyses available in patients undergoing ABMT support a cost reduction of about 25 to 35% with rGM-CSF therapy, relative to placebo , generated primarily by decreases of 20 to 30% in hospitalisation cos ts reflecting reductions in length of hospitalisation. Results of I tr ial show equivalent cost savings of 40% versus placebo with either rGM -CSF ol recombinant granulocyte colony-stimulating factor (rG-CSF) in patients with chemotherapy-induced febrile neutropenia. Whether reduce d infection rates seen with rGM-CSF may lessen costs of antimicrobial therapy is undetermined; however a 16% decrease in this cost factor wa s reported in I evaluation of high dose chemotherapy with ABMT: No ana lyses have assessed the cost effectiveness of rGM-CSF as prophylaxis i n patients receiving chemotherapy.Survival rates have increased in pat ients treated with rGM-CSF after bone marrow graft failure. In contras t, with the exception of one small trial, improvements in mortality or relapse rates have not occurred with rGM-CSF used prophylactically wi th chemotherapy, despite favourable effects on neutrophil recovery and facilitation of dose-intensified chemotherapy regimens. Similarly, su rvival has not increased in patients undergoing ABMT The long term eco nomic impact of rGM-CSF in these indications is thus unknown. Other fa ctors predicted to produce modest cost savings include possible reduct ions in expenditure related to treating mucositis, and lowered transfu sion requirements in some patients. Whether rGM-CSF may provide benefi ts in other areas that can be expressed in economic terms, such as qua lity of life, also remains to be established. On the whole, rCM-CSF ha s a good tolerability profile, obviating the need for costly monitorin g procedures. Like other expensive biotechnology products, its cost ef fectiveness will be aided by implementation of appropriate prescribing techniques and protocols to minimise wastage. Thus, at present rGM-CS F therapy appears to offer a means of reducing hospitalisation costs, and therefore a substantial component of treatment expenditure, in pat ients undergoing ABMT or with chemotherapy-induced febrile neutropenia .