The myeloid growth factors granulocyte-macrophage colony-stimulating f
actor (GM-CSF) and granulocyte colony-stimulating factor (G-CSF) have
tremendous potential in the treatment of cancer. Because of their rela
tively high cost per dose, the availability of these factors has raise
d important issues regarding their effect on healthcare costs. The eff
ects of therapy with GM-CSF and G-CSF on overall healthcare costs will
depend upon: (a) the clinical setting in which they are being used; (
b) the cost savings, if any, associated with their efficacy; and (c) t
he dosage and schedule used. When used to prevent febrile neutropenia
in patients receiving standard dosage chemotherapy, the effect of the
myeloid growth factors on healthcare costs is dependent upon the risk
of febrile neutropenia if the growth factor is not used, and upon the
magnitude of risk reduction associated with use of that particular fac
tor. The published data suggest that the use of G-CSF is associated wi
th a 50% reduction in risk of febrile neutropenia. Our analyses sugges
t that in most settings the use of G-CSF will be cost saving when the
risk of febrile neutropenia in untreated patients exceeds 30%. When us
ed to treat established febrile neutropenia, the available data sugges
t that the myeloid growth factors may decrease the duration of neutrop
enia, but that they do not decrease resource consumption to such an ex
tent that they fully offset their acquisition costs. When used to faci
litate chemotherapy dosage intensification, the myeloid growth factors
decrease the morbidity of therapy and decrease resource consumption t
o such an extent that both GM-CSF and G-CSF fully offset their own cos
ts. This is particularly true when these factors are used to mobilise
peripheral blood progenitor cells. Used in this fashion, 2 doses of GM
-CSF or G-CSF administered to the entire patient population will decre
ase resource consumption by approximately 1 day in hospital. However,
these high dosage chemotherapy regimens remain more costly than standa
rd dosage chemotherapy, with or without growth factor support. The cos
t effectiveness of the dosage intensification strategy must be measure
d in terms of patient outcomes, including duration of survival and qua
lity of life.