AN ECONOMIC-EVALUATION OF THE USE OF GRANULOCYTE-COLONY-STIMULATING FACTOR AFTER BONE-MARROW TRANSPLANTATION IN CHILDREN

Studies that have assessed the use of granulocyte colony-stimulating f actor (G-CSF) following bone marrow transplantation have shown a signi ficantly reduced time to neutrophil recovery with the use of this agen t, which may translate into a reduced duration of antimicrobial therap y and hospitalisation. We performed a pharmacoeconomic study evaluatin g the elective use of G-CSF after bone marrow transplantation in child ren. 22 consecutive children who underwent bone marrow transplantation and received G-CSF 5 mu g/kg/day were compared with 18 such children (control group) who did not receive G-CSF Despite a significant reduct ion in time to recovery of the absolute neutrophil count (ANC) to >0.5 x 10/L in G-CSF recipients compared with the control group (14 days v s 20.9 days; p < 0.0001), there was only a trend towards a reduction i n the duration of intravenous antimicrobial therapy (14.5 days vs 18.6 days; p = 0.15), and there was no significant difference in the durat ion of hospitalisation (25.3 days vs 29.8 days). Reasons for prolonged hospitalisation beyond ANC recovery included continued use of total p arenteral nutrition, treatment of graft-versus-host disease and treatm ent of ongoing infection. Overall, the mean total cost for patients re ceiving G-CSF was pound 15 001, compared with pound 15 482 for the con trol group (1995 values). In conclusion, while there appears to be no benefit in financial terms, the release of a child from strict isolati on as a result of early ANC recovery must be taken into consideration.