Cost of Filgrastim

Although the use of filgrastim in the treatment of breast cancer may improve dose intensity in the adjuvant setting and aid in the use of combinations of potent chemother-apeutic agents in the metastatic setting, it is a costly treatment. Several cost analyses have been developed to assess the cost effectiveness of prophylactic filgrastim.

Glaspy et al. (31) evaluated 68 patients with SCLC receiving CAE chemotherapy randomly assigned to receive filgrastim or placebo 24 h after chemotherapy until the ANC was < 10 x 109/L. Patients who received filgrastim had fewer hospitalizations; if they were hospitalized, they had shorter durations of stay and less utilization of resources. The authors concluded that cost savings occurred with the use of filgrastim in patient settings in which the risk of FN was high.

Silber et al. (32) used their risk assessment model of first-course nadir ANC and hemoglobin concentration to assess the cost effectiveness of filgrastim in the adjuvant treatment of breast cancer. All patients received their first course of therapy without fil-grastim. Patients who were determined to exceed a threshold value that was predetermined based on first-cycle ANC and hemoglobin concentration received filgrastim for subsequent courses of chemotherapy. Although the authors felt that the cost estimates were insensitive to hospitalization costs, if the neediest 50% of patients were treated with filgrastim, a cost-effectiveness ratio of US $34,297 per life-year saved was estimated, on a par for the treatment of other medical conditions.

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