Routine use of granulocyte colony-stimulating factor is not cost-effective and does not increase patient comfort in the treatment of small-cell lung cancer: An analysis using a Markov model

被引:45
作者
Chouaid, C [1 ]
Bassinet, L [1 ]
Fuhrman, C [1 ]
Monnet, I [1 ]
Housset, B [1 ]
机构
[1] Ctr Hosp Intercommunal, Serv Pneumol, Creteil, France
关键词
D O I
10.1200/JCO.1998.16.8.2700
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: The clinical indications and economic consequences of human granulocyte colony-stimulating factar (G-CSF) prescription during small-cell lung cancer (SCLC) chemotherapy remain controversial. The aim of this study, based on a Markov model, was to assess the impact of routine G-CSF use in the treatment of SCLC on costs and patient comfort. Markov models allow the modeling SCLC chemotherapy, in which the risk of febrile neutropenia (FN) is continuous over time and may occur more than once. Patients and Methods: We used a Markov model to compare three strategies: a chemotherapy dose reduction after FN and nonuse of G-CSF ("never" strategy), secondary use of G-CSF ("CSF if FN" strategy) and primary use of G-CSF ("systematic CSF" strategy). Model baseline probabilities were based on a review of medical records for all patients (n = 39) treated for SCLC in our unit during 1993 (when G-CSF was not used) and on published reductions in the incidence of FN obtained by using G-CSF. Two different types of rewards were used: a cast-utility scale that took into account the costs of FN (CFN) episodes and G-CSF (CCSF) courses; and a comfort-utility scale that took into account the discomfort of FN and G-CSF therapy. Costs were analyzed from the health care payer's perspective and utilities were assessed prospectively in standardized interviews with treated SCLC patients. Results: The never strategy was the least costly ($4,875 [United States] versus $5,816 and $7,690 for CSF if FN and systematic CSF) and gave the highest comfort value (378 U v 365 and 327 for CSF if FN and systematic CSF). Sensitivity analyses showed that the never strategy remains the less costly when the probability of a first FN episode was less than 49%, the probability of FN recurrence was less than 60%, or the CFN was less than $6,077, or the CCSF was greater than $863. In terms of patient comfort, the never strategy was the best choice, except for patients who considered that a course of G-CSF caused little or no discomfort whether or not it prevented FN. Conclusion: Routine use of G-CSF during SCLC chemotherapy is not justified by clinical benefits, improved patient comfort, or economic considerations. J Clin Oncol 16: 2700-2707. (C) 1998 by American Society of Clinical Oncology.
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页码:2700 / 2707
页数:8
相关论文
共 29 条
[1]  
[Anonymous], 1994, J CLIN ONCOL, V12, P2471
[2]   INITIAL CHEMOTHERAPEUTIC DOSES AND SURVIVAL IN PATIENTS WITH LIMITED SMALL-CELL LUNG-CANCER [J].
ARRIAGADA, R ;
LECHEVALIER, T ;
PIGNON, JP ;
RIVIERE, A ;
MONNET, I ;
CHOMY, P ;
TUCHAIS, C ;
TARAYRE, M ;
RUFFIE, P .
NEW ENGLAND JOURNAL OF MEDICINE, 1993, 329 (25) :1848-1852
[3]   Use of hematopoietic colony-stimulating factors: The American Society of Clinical Oncology survey [J].
Bennett, CL ;
Smith, TJ ;
Weeks, JC ;
Bredt, AB ;
Feinglass, J ;
Fetting, JH ;
Hillner, BE ;
Somerfield, MR ;
Winn, RJ .
JOURNAL OF CLINICAL ONCOLOGY, 1996, 14 (09) :2511-2520
[4]   CHEMORADIOTHERAPY WITH OR WITHOUT GRANULOCYTE-MACROPHAGE COLONY-STIMULATING FACTOR IN THE TREATMENT OF LIMITED-STAGE SMALL-CELL LUNG-CANCER - A PROSPECTIVE PHASE-III RANDOMIZED STUDY OF THE SOUTHWEST-ONCOLOGY-GROUP [J].
BUNN, PA ;
CROWLEY, J ;
KELLY, K ;
HAZUKA, MB ;
BEASLEY, K ;
UPCHURCH, C ;
LIVINGSTON, R .
JOURNAL OF CLINICAL ONCOLOGY, 1995, 13 (07) :1632-1641
[5]   REDUCTION BY GRANULOCYTE COLONY-STIMULATING FACTOR OF FEVER AND NEUTROPENIA INDUCED BY CHEMOTHERAPY IN PATIENTS WITH SMALL-CELL LUNG-CANCER [J].
CRAWFORD, J ;
OZER, H ;
STOLLER, R ;
JOHNSON, D ;
LYMAN, G ;
TABBARA, I ;
KRIS, M ;
GROUS, J ;
PICOZZI, V ;
RAUSCH, G ;
SMITH, R ;
GRADISHAR, W ;
YAHANDA, A ;
VINCENT, M ;
STEWART, M ;
GLASPY, J .
NEW ENGLAND JOURNAL OF MEDICINE, 1991, 325 (03) :164-170
[6]   A CLINICIAN GUIDE TO COST-EFFECTIVENESS ANALYSIS [J].
DETSKY, AS ;
NAGLIE, IG .
ANNALS OF INTERNAL MEDICINE, 1990, 113 (02) :147-154
[7]  
Faulds D, 1992, Pharmacoeconomics, V1, P231
[8]   FILGRASTIM - A REVIEW OF ITS PHARMACOLOGICAL PROPERTIES AND THERAPEUTIC EFFICACY IN NEUTROPENIA [J].
FRAMPTON, JE ;
LEE, CR ;
FAULDS, D .
DRUGS, 1994, 48 (05) :731-760
[9]   CODE chemotherapy with and without granulocyte colony-stimulating factor in small-cell lung cancer [J].
Fukuoka, M ;
Masuda, N ;
Negoro, S ;
Matsui, K ;
Yana, T ;
Kudoh, S ;
Kusunoki, Y ;
Takada, M ;
Kawahara, M ;
Ogawara, N ;
Kodama, N ;
Kubota, K ;
Furuse, K .
BRITISH JOURNAL OF CANCER, 1997, 75 (02) :306-309
[10]   Increasing the dose intensity of chemotherapy by means of granulocyte-colony stimulating factor (G-CSF) support in the treatment of small cell lung cancer (SCLC) [J].
Girling, DJ ;
Thatcher, N ;
Clark, PI ;
Stephens, RJ .
EUROPEAN JOURNAL OF CANCER, 1996, 32A (07) :1263-1263