Use of colony-stimulating factors with chemotherapy: opportunities for cost savings and improved outcomes

Arnold L Potosky; Jennifer L Malin; Benjamin Kim; Elizabeth A Chrischilles; Solomon B Makgoeng; Nadia Howlader; Jane C Weeks

doi:10.1093/jnci/djr152

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Use of colony-stimulating factors with chemotherapy: opportunities for cost savings and improved outcomes

Journal article

Open access

Peer reviewed

Use of colony-stimulating factors with chemotherapy: opportunities for cost savings and improved outcomes

Arnold L Potosky, Jennifer L Malin, Benjamin Kim, Elizabeth A Chrischilles, Solomon B Makgoeng, Nadia Howlader and Jane C Weeks

JNCI : Journal of the National Cancer Institute, Vol.103(12), pp.979-982

06/22/2011

DOI: 10.1093/jnci/djr152

PMCID: PMC3119647

PMID: 21670423

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Abstract

Myeloid colony-stimulating factors (CSFs) decrease the risk of febrile neutropenia (FN) from high-risk chemotherapy regimens administered to patients at 20% or greater risk of FN, but little is known about their use in clinical practice. We evaluated CSF use in a multiregional population-based cohort of lung and colorectal cancer patients (N = 1849). Only 17% (95% confidence interval [CI] = 8% to 26%) patients treated with high-risk chemotherapy regimens received CSFs, compared with 18% (95% CI = 16% to 20%) and 10% (95% CI = 8% to 12%) of patients treated with intermediate- (10%-20% risk of FN) and low-risk (<10% risk of FN) chemotherapy regimens, respectively. Using a generalized estimating equation model, we found that enrollment in a health maintenance organization (HMO) was strongly associated with a lower adjusted odds of discretionary CSF use, compared with non-HMO patients (odds ratio = 0.44, 95% CI = 0.32 to 0.60, P < .001). All statistical tests were two-sided. Overall, 96% (95% CI = 93% to 98%) of CSFs were administered in scenarios where CSF therapy is not recommended by evidence-based guidelines. This finding suggests that policies to decrease CSF use in patients at lower or intermediate risk of FN may yield substantial cost savings without compromising patient outcomes.

Lung Neoplasms - drug therapy

United States

Humans

Middle Aged

Male

Antineoplastic Agents - administration & dosage

Cost Savings

Neutropenia - complications

Drug Prescriptions - economics

Antineoplastic Agents - adverse effects

Colorectal Neoplasms - drug therapy

Adult

Female

Neutropenia - chemically induced

Odds Ratio

Risk Factors

Treatment Outcome

Evidence-Based Medicine

Drug Prescriptions - statistics & numerical data

Colony-Stimulating Factors - economics

Neutropenia - prevention & control

Fever - etiology

Fever - prevention & control

Aged

Health Maintenance Organizations

Colony-Stimulating Factors - administration & dosage

Cohort Studies

Practice Guidelines as Topic

Details

Title: Subtitle: Use of colony-stimulating factors with chemotherapy: opportunities for cost savings and improved outcomes
Creators: Arnold L Potosky - Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven St NW, Ste 4100, Washington, DC 20007, USA. alp49@georgetown.edu
Jennifer L Malin
Benjamin Kim
Elizabeth A Chrischilles
Solomon B Makgoeng
Nadia Howlader
Jane C Weeks
Resource Type: Journal article
Publication Details: JNCI : Journal of the National Cancer Institute, Vol.103(12), pp.979-982
Publisher: United States
DOI: 10.1093/jnci/djr152
PMID: 21670423
PMCID: PMC3119647
ISSN: 1460-2105
eISSN: 1460-2105
Grant note: U01 CA093344 / NCI NIH HHS U01 CA093326 / NCI NIH HHS U01 CA093339 / NCI NIH HHS U01 CA093324 / NCI NIH HHS U01 CA093332 / NCI NIH HHS U01 CA093348 / NCI NIH HHS U01 CA093329 / NCI NIH HHS
Language: English
Date published: 06/22/2011
Academic Unit: Pharmacy; Epidemiology
Record Identifier: 9983996094602771

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