Economic analysis of granulocyte colony stimulating factor as adjunct therapy for older patients with acute myelogenous leukemia (AML): Estimates from a Southwest Oncology Group clinical trial

Considerable morbidity, mortality, and economic costs result during remissi on induction therapy for elderly patients with acute myeloid leukemia (AML) . in this study, the economic costs of adjunct granulocyte colony stimulati ng factor (G-CSF) are estimated for AML patients > 55 years of age who rece ived induction chemotherapy on a recently completed Southwest Oncology Grou p study (SWOG). Clinical data were based on Phase III trial information fro m 207 AML patients who were randomized to receive either placebo or G-CSF p ost-induction therapy. Analyses were conducted using a decision analytic mo del with the primary source of clinical event probabilities based on in-hos pital care with or without all active infection requiring intravenous antib iotics. Estimates of average daily costs of care with and without an infect ion were impoted from a previously reported economic model of a similar pop ulation. When compared to AML patients who received placebo, patients who r eceived G-CSF had significantly fewer days on intravenous antibiotics (medi an 22 vs. 26, p = 0.05), whereas overall duration of hospitalzation did not differ (median 29 days). The median cost per day with all active infection that required intravenous antibiotics was estimated to be $1742, whereas t he median cost per day without an active infection was estimated to De $146 7. Overall costs were $49, 693 for the placebo group and $50,593 for the G- CSF patients. G-CSF during induction chemotherapy for elderly patients with AML had some clinical benefits, but it did not reduce the duration of hosp italization, prolong survival, or reduce the overall cost of supportive car e. Whether the benefits of G-CSF therapy justify its use in individual pati ents with acute leukemia for the present remains a matter of clinical judge ment.