Economic analysis of a phase III study of G-CSF vs placebo following allogeneic blood stem cell transplantation

Hematopoietic colony-stimulating factors (CSF) decrease the duration of neu tropenia following stem cell transplantation (SCT, With CSF-mobilized allog eneic blood SCT (alloBSCT), the yields of CD34(+) cells are several-fold hi gher than in other SCT settings, raising concern that post-transplant CSF u se may be unnecessary. In this study, we estimate the resource and cost imp lications associated with CSF use following alloBSCT, A cost identification analysis was conducted for 44 patients on a randomized, double-blind place bo-controlled trial of G-CSF following alloBSCT, Study drug was given daily until an absolute neutrophil count (ANC) greater than or equal to 1000 cel ls/mu l. Billing information from the time of transplant to day +100 was an alyzed. The median number of days to an ANC greater than or equal to 500 ce lls/mu l was shorter in the G-CSF arm, 10.5 days vs 15 days (P < 0.001), wh ile platelet recovery and rates of acute graft-versus-host disease (GVHD) a nd survival were similar. Resource use was similar, including days hospital ized, days on antibiotics, blood products transfused and outpatient visits. Total median post-transplant costs were $76 577 for G-CSF patients and $78 799 for placebo patients (P=0.93), G-CSF following allogeneic blood SCT de creased the median duration of absolute neutropenia and did not incur addit ional costs, but did not result in shorter hospitalizations, or less freque nt antibiotic use.