Granulocyte colony-stimulating factor for chemotherapy-induced neutropenia in patients with small cell lung cancer

The 40% rule revisited

Elizabeth A. Calhoun*, Glen T. Schumock, June M McKoy, Simon Pickard, Karen A. Fitzner, Elizabeth A. Heckinger, Eowyn F. Powell, Kathyrn R. McCaffrey, Charles L. Bennett

*Corresponding author for this work

Research output: Contribution to journalReview article

15 Citations (Scopus)

Abstract

Recombinant granulocyte colony-stimulating factor (G-CSF) [filgrastim and lenograstim] and pegylated G-CSF (pegfilgrastim) have been shown to reduce the severity and duration of chemotherapy-associated febrile neutropenia (FN) when administered prophylactically to cancer patients receiving chemotherapeutic regimens. The American Society of Clinical Oncology (ASCO) evidence-based clinical guidelines published in 1994, 1996 and 1997 recommended primary prophylaxis with G-CSF for cancer patients. The 2000 ASCO update, with the same recommendation, highlights the importance of economic considerations in decision making for CSFs. This paper reviews the available cost-effectiveness evidence on the use of G-CSF as primary prophylaxis against FN in patients with small cell lung cancer (SCLC). Cost-effectiveness ratios from a healthcare payer perspective supported the use of filgrastim as primary prophylaxis for people with SCLC, on the basis of both clinical and economic benefits, treated with chemotherapeutic regimens that have an FN rate in the range of 40-60%. However, when indirect and patient out-of-pocket costs attributable to severe FN are included, available evidence suggests that the risk threshold may be reduced by more than half. Given that FN rates associated with chemotherapeutic regimens for SCLC are generally <40%, then few circumstances would warrant the use of G-CSFs (filgrastim and lenograstim) under the current rule. However, inclusion of indirect costs would lower the cost-effectiveness threshold. Future cost-effectiveness studies of medications such as pegfilgrastim should attempt to capture the societal perspective by incorporating productivity-related costs and using base-case rates of FN reported in the literature.

Original languageEnglish (US)
Pages (from-to)767-775
Number of pages9
JournalPharmacoEconomics
Volume23
Issue number8
DOIs
StatePublished - Oct 17 2005

Fingerprint

Febrile Neutropenia
Small Cell Lung Carcinoma
Granulocyte Colony-Stimulating Factor
Neutropenia
Drug Therapy
Cost-Benefit Analysis
Economics
Costs and Cost Analysis
Medical Oncology
Health Expenditures
Neoplasms
Decision Making
Guidelines
Delivery of Health Care
Filgrastim

ASJC Scopus subject areas

  • Pharmacology
  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

Calhoun, Elizabeth A. ; Schumock, Glen T. ; McKoy, June M ; Pickard, Simon ; Fitzner, Karen A. ; Heckinger, Elizabeth A. ; Powell, Eowyn F. ; McCaffrey, Kathyrn R. ; Bennett, Charles L. / Granulocyte colony-stimulating factor for chemotherapy-induced neutropenia in patients with small cell lung cancer : The 40% rule revisited. In: PharmacoEconomics. 2005 ; Vol. 23, No. 8. pp. 767-775.
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title = "Granulocyte colony-stimulating factor for chemotherapy-induced neutropenia in patients with small cell lung cancer: The 40{\%} rule revisited",
abstract = "Recombinant granulocyte colony-stimulating factor (G-CSF) [filgrastim and lenograstim] and pegylated G-CSF (pegfilgrastim) have been shown to reduce the severity and duration of chemotherapy-associated febrile neutropenia (FN) when administered prophylactically to cancer patients receiving chemotherapeutic regimens. The American Society of Clinical Oncology (ASCO) evidence-based clinical guidelines published in 1994, 1996 and 1997 recommended primary prophylaxis with G-CSF for cancer patients. The 2000 ASCO update, with the same recommendation, highlights the importance of economic considerations in decision making for CSFs. This paper reviews the available cost-effectiveness evidence on the use of G-CSF as primary prophylaxis against FN in patients with small cell lung cancer (SCLC). Cost-effectiveness ratios from a healthcare payer perspective supported the use of filgrastim as primary prophylaxis for people with SCLC, on the basis of both clinical and economic benefits, treated with chemotherapeutic regimens that have an FN rate in the range of 40-60{\%}. However, when indirect and patient out-of-pocket costs attributable to severe FN are included, available evidence suggests that the risk threshold may be reduced by more than half. Given that FN rates associated with chemotherapeutic regimens for SCLC are generally <40{\%}, then few circumstances would warrant the use of G-CSFs (filgrastim and lenograstim) under the current rule. However, inclusion of indirect costs would lower the cost-effectiveness threshold. Future cost-effectiveness studies of medications such as pegfilgrastim should attempt to capture the societal perspective by incorporating productivity-related costs and using base-case rates of FN reported in the literature.",
author = "Calhoun, {Elizabeth A.} and Schumock, {Glen T.} and McKoy, {June M} and Simon Pickard and Fitzner, {Karen A.} and Heckinger, {Elizabeth A.} and Powell, {Eowyn F.} and McCaffrey, {Kathyrn R.} and Bennett, {Charles L.}",
year = "2005",
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Calhoun, EA, Schumock, GT, McKoy, JM, Pickard, S, Fitzner, KA, Heckinger, EA, Powell, EF, McCaffrey, KR & Bennett, CL 2005, 'Granulocyte colony-stimulating factor for chemotherapy-induced neutropenia in patients with small cell lung cancer: The 40% rule revisited', PharmacoEconomics, vol. 23, no. 8, pp. 767-775. https://doi.org/10.2165/00019053-200523080-00003

Granulocyte colony-stimulating factor for chemotherapy-induced neutropenia in patients with small cell lung cancer : The 40% rule revisited. / Calhoun, Elizabeth A.; Schumock, Glen T.; McKoy, June M; Pickard, Simon; Fitzner, Karen A.; Heckinger, Elizabeth A.; Powell, Eowyn F.; McCaffrey, Kathyrn R.; Bennett, Charles L.

In: PharmacoEconomics, Vol. 23, No. 8, 17.10.2005, p. 767-775.

Research output: Contribution to journalReview article

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T1 - Granulocyte colony-stimulating factor for chemotherapy-induced neutropenia in patients with small cell lung cancer

T2 - The 40% rule revisited

AU - Calhoun, Elizabeth A.

AU - Schumock, Glen T.

AU - McKoy, June M

AU - Pickard, Simon

AU - Fitzner, Karen A.

AU - Heckinger, Elizabeth A.

AU - Powell, Eowyn F.

AU - McCaffrey, Kathyrn R.

AU - Bennett, Charles L.

PY - 2005/10/17

Y1 - 2005/10/17

N2 - Recombinant granulocyte colony-stimulating factor (G-CSF) [filgrastim and lenograstim] and pegylated G-CSF (pegfilgrastim) have been shown to reduce the severity and duration of chemotherapy-associated febrile neutropenia (FN) when administered prophylactically to cancer patients receiving chemotherapeutic regimens. The American Society of Clinical Oncology (ASCO) evidence-based clinical guidelines published in 1994, 1996 and 1997 recommended primary prophylaxis with G-CSF for cancer patients. The 2000 ASCO update, with the same recommendation, highlights the importance of economic considerations in decision making for CSFs. This paper reviews the available cost-effectiveness evidence on the use of G-CSF as primary prophylaxis against FN in patients with small cell lung cancer (SCLC). Cost-effectiveness ratios from a healthcare payer perspective supported the use of filgrastim as primary prophylaxis for people with SCLC, on the basis of both clinical and economic benefits, treated with chemotherapeutic regimens that have an FN rate in the range of 40-60%. However, when indirect and patient out-of-pocket costs attributable to severe FN are included, available evidence suggests that the risk threshold may be reduced by more than half. Given that FN rates associated with chemotherapeutic regimens for SCLC are generally <40%, then few circumstances would warrant the use of G-CSFs (filgrastim and lenograstim) under the current rule. However, inclusion of indirect costs would lower the cost-effectiveness threshold. Future cost-effectiveness studies of medications such as pegfilgrastim should attempt to capture the societal perspective by incorporating productivity-related costs and using base-case rates of FN reported in the literature.

AB - Recombinant granulocyte colony-stimulating factor (G-CSF) [filgrastim and lenograstim] and pegylated G-CSF (pegfilgrastim) have been shown to reduce the severity and duration of chemotherapy-associated febrile neutropenia (FN) when administered prophylactically to cancer patients receiving chemotherapeutic regimens. The American Society of Clinical Oncology (ASCO) evidence-based clinical guidelines published in 1994, 1996 and 1997 recommended primary prophylaxis with G-CSF for cancer patients. The 2000 ASCO update, with the same recommendation, highlights the importance of economic considerations in decision making for CSFs. This paper reviews the available cost-effectiveness evidence on the use of G-CSF as primary prophylaxis against FN in patients with small cell lung cancer (SCLC). Cost-effectiveness ratios from a healthcare payer perspective supported the use of filgrastim as primary prophylaxis for people with SCLC, on the basis of both clinical and economic benefits, treated with chemotherapeutic regimens that have an FN rate in the range of 40-60%. However, when indirect and patient out-of-pocket costs attributable to severe FN are included, available evidence suggests that the risk threshold may be reduced by more than half. Given that FN rates associated with chemotherapeutic regimens for SCLC are generally <40%, then few circumstances would warrant the use of G-CSFs (filgrastim and lenograstim) under the current rule. However, inclusion of indirect costs would lower the cost-effectiveness threshold. Future cost-effectiveness studies of medications such as pegfilgrastim should attempt to capture the societal perspective by incorporating productivity-related costs and using base-case rates of FN reported in the literature.

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