THE IMPACT OF THERAPY WITH FILGRASTIM (RECOMBINANT GRANULOCYTE-COLONY-STIMULATING FACTOR) ON THE HEALTH-CARE COSTS ASSOCIATED WITH CANCER-CHEMOTHERAPY

The objective of the study was to estimate the net impact on health re source utilisation of using recombinant granulocyte colony-stimulating factor (filgrastim) following myelosuppressive chemotherapy. Cost min imisation of the study medication in a randomised, double-blind, place bo-controlled clinical trial was conducted in teaching institutions an d affiliated community hospitals participating in a clinical trial. 68 patients with small cell lung cancer undergoing cyclophosphamide, dox orubicin and etoposide chemotherapy were randomised to blinded placebo or filgrastim study medication at three or 14 clinical trials sites. The patients received daily subcutaneous injections of filgrastim or p lacebo, initiated 24 h after chemotherapy and continued until the neut rophil count exceeded 10 000 x 10(6)/1 after the time of the expected nadir. Differences in total charges, costs and Medicare payments betwe en treatment groups were the main outcomes measured. Compared to place bo patients, filgrastim-treated patients had significantly fewer and l ess resource-intensive hospitalisations. After accounting for filgrast im purchase and administration, the charge model predicts overall savi ngs from filgrastim use in a clinical setting in which the risk of feb rile neutropenia is high for patients not receiving filgrastim. The Me dicare and cost models predict only a partial recapture of the cost of filgrastim therapy. The health care resources impact of filgrastim wa s sensitive to the risk of hospitalisation with febrile neutropenia, a nd to the perspective chosen for measuring resource utilisation (charg es, costs or Medicare payments). The adjunctive use of filgrastim foll owing myelosuppressive chemotherapy leads to partial or complete recap ture of the cost of purchasing and administering the product.