Lee, S., Knox, A., Zeng, I.S., Coomarasamy, C., Blacklock, H., & Issa, S. (2013). Primary prophylaxis with granulocyte colony-stimulating factor (GCSF) reduces the incidence of febrile neutropenia in patients with non-Hodgkin lymphoma (NHL) receiving CHOP chemotherapy treatment without adversely affecting their quality of life: Cost-benefit and quality of life analysis. Supportive Care in Cancer, 21, 841–846.

To examine the cost-benefit of primary prophylaxis with granulocyte colony-stimulating factor (G-CSF) in patients with non-Hodgkin lymphoma (NHL) receiving cyclophosphamide, vincristine, doxorubicin, and prednisone (CHOP) chemotherapy

In 2007, the study site implemented standard primary prophylaxis with G-CSF in this group of patients. Outcomes were compared to a historical control group that had not received primary prophylaxis. Analysis of cost was based on institutional direct costs for treatment of febrile neutropenia (FN).

• N = 65
• MEDIAN AGE = 61 years
• AGE RANGE = 20–85 years
• MALES: 51%, FEMALES: 49%
• KEY DISEASE CHARACTERISTICS: All had NHL and were receiving R-CHOP chemotherapy
• OTHER KEY SAMPLE CHARACTERISTICS: Patients receiving hematopoietic stem cell transplantation were excluded.

• SITE: Single site
• SETTING TYPE: Inpatient 
• LOCATION: New Zealand

• PHASE OF CARE: Active antitumor treatment

• Retrospective, descriptive, two-group comparison

• Incidence of FN

Patients who received primary G-CSF prophylaxis were compared to a group of patients who did not receive primary prophylaxis prior to 2007, when primary prophylaxis was instituted as the standard of care for these patients. Among those who received prophylaxis, the incidence of FN was 5%, compared to 60% of those who had not received prophylaxis (p < .0001). Cost-benefit analysis using the number needed to treat and the average cost of an FN episode showed that prophylaxis increased the cost by $238 (New Zealand dollars), including only direct costs.

Primary G-CSF prophylaxis was associated with a significant reduction in the incidence of FN for a small additional cost of overall care throughout CHOP chemotherapy.

• Small sample (less than 100)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Measurement/methods not well described
• Findings not generalizable
• Other limitations/explanation: The definition of FN used in the study is not provided. Costs may not be applicable to those in other countries.

Primary G-CSF prophylaxis was associated with significantly lower prevalence of FN. Based only on direct healthcare costs, this study showed that primary prophylaxis was associated with a small, incremental increased cost, but these data do not account for other indirect costs and the full range of healthcare utilization that may be associated with treatment of FN. The authors concluded that primary prophylaxis in this group of patients was cost-effective. The cost-benefit of primary G-CSF prophylaxis has been a recent area of interest in oncology care. Further, well-designed economic analyses would be useful in exploring these questions among varied groups of patients.