Colony Stimulating Factors

The recombinant colony-stimulating factors (CSFs) are capable of reducing the severity and duration of neutropenia. CSFs reduce the risk of FN and documented infections and also facilitate the delivery of full dose intensity in patients receiving cancer chemotherapy (17). Although such a use is perhaps more controversial, CSFs given to patients admitted for established FN appear to reduce the duration of neutropenia and the proportion of patients with prolonged hospitalization (18). The decision to use recombinant human granulocyte colony-stimulating factor (rHuG-CSF) involves the clinical efficacy, the impact on patient QOL, and the cost associated with neutropenia and its sequelae. Decision models evaluating the use of CSFs to reduce the risk of FN in patients receiving chemotherapy have been studied (19,20). These models have been used to support the development of clinical practice guidelines for the use of CSFs in cancer therapy (21,22). Such models, however, are highly sensitive to the cost assumptions used. The economics of the hematopoietic growth factors (HGFs) have been found to largely represent the economics of neutropenia and its complications, particularly FN (23-25). An improved understanding of the actual costs associated with the management of FN can provide a more rational basis for evaluating CSFs and further refining of clinical practice guidelines. We summarize the available literature related to the efficacy, cost, and cost effectiveness of CSFs in patients receiving cancer chemotherapy at risk for neutropenia and its consequences.

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