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Comparison of hospitalization risk and associated costs among patients receiving sargramostim, filgrastim, and pegfilgrastim for chemotherapy-Induced neutropenia†

  1. Mark L. Heaney MD, PhD1,‡,*,
  2. Edmond L. Toy PhD2,
  3. Francis Vekeman MA3,
  4. François Laliberté MA3,
  5. Bree L. Dority PhD2,
  6. Daniel Perlman BA2,
  7. Victoria Barghout MSPH4,
  8. Mei Sheng Duh MPH, ScD5

Article first published online: 27 JUL 2009

DOI: 10.1002/cncr.24535

Issue

Cancer

Cancer

Volume 115, Issue 20, pages 4839–4848, 15 October 2009

Additional Information

How to Cite

Heaney, M. L., Toy, E. L., Vekeman, F., Laliberté, F., Dority, B. L., Perlman, D., Barghout, V. and Duh, M. S. (2009), Comparison of hospitalization risk and associated costs among patients receiving sargramostim, filgrastim, and pegfilgrastim for chemotherapy-Induced neutropenia. Cancer, 115: 4839–4848. doi: 10.1002/cncr.24535

Author Information

  1. 1

    Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York

  2. 2

    Analysis Group, Inc, Lakewood, Colorado

  3. 3

    Analysis Group, Inc, Montreal, Quebec, Canada

  4. 4

    U.S. Health Economics and Outcomes Research Division, Bayer HealthCare Pharmaceuticals, Inc, Wayne, New Jersey

  5. 5

    Analysis Group, Inc, Boston, Massachusetts

  1. ‡

    Fax: (212) 772-8550

*Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065

  1. †

    Presented in part at the 50th Annual Meeting and Exposition of the American Society of Hematology, San Francisco, California, December 6-9, 2008.

Publication History

  1. Issue published online: 5 OCT 2009
  2. Article first published online: 27 JUL 2009
  3. Manuscript Accepted: 1 MAY 2009
  4. Manuscript Revised: 19 MAR 2009
  5. Manuscript Received: 22 DEC 2008

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Keywords:

  • neutropenia;
  • colony-stimulating factors;
  • infection;
  • treatment costs

Using retrospective data from health insurance claims, the authors examined the real-world use of myeloid growth factors for the prevention/treatment of chemotherapy-induced neutropenia. They found that granulocyte-macrophage–colony-stimulating factor (sargramostim) reduced the risk and cost of infection-related hospitalizations more than granulocyte–colony-stimulating factor (filgrastim and pegfilgrastim).

Abstract

BACKGROUND:

Sargramostim is a granulocyte-macrophage–colony-stimulating factor (GM-CSF). Unlike filgrastim and pegfilgrastim, which are granulocyte–colony-stimulating factors (G-CSFs), sargramostim activates a broader range of myeloid lineage-derived cells. Therefore, GM-CSF might reduce infection risk more than the G-CSFs. This study compared real-world infection-related hospitalization rates and costs in patients using G/GM-CSF for chemotherapy-induced neutropenia.

METHODS:

This retrospective matched-cohort study analyzed nationally representative health insurance claims in the United States from 2000 through 2007. The sample population included patients who received chemotherapy and G/GM-CSF. G/GM-CSF treatment episodes began with the first administration of G/GM-CSF and ended when a subsequent administration was >28 days after a prior administration. Sargramostim patients were matched 1:1 with filgrastim and pegfilgrastim patients based on gender and birth year. Outcomes included infection-related hospitalization rates and the associated costs. Hospitalization rates were analyzed using univariate and multivariate Poisson methods; covariates included myelosuppressive agents received, tumor type, anemia, and comorbidities.

RESULTS:

A total of 990 sargramostim-filgrastim and 982 sargramostim-pegfilgrastim matched pairs were analyzed. Cohorts were similar with regard to age, gender, and comorbid conditions. Several differences were observed with regard to tumor type, anemia, and chemotherapy, but no systematic trends were apparent. Sargramostim patients experienced a 56% lower risk of infection-related hospitalizations compared with filgrastim and pegfilgrastim patients. Infection-related hospitalization costs were 84% and 62% lower for sargramostim patients compared with patients treated with filgrastim and pegfilgrastim, respectively.

CONCLUSIONS:

Among patients with or at risk for chemotherapy-induced neutropenia, these data indicated that use of sargramostim was associated with a reduced risk of infection-related hospitalization and lower associated costs compared with filgrastim or pegfilgrastim. Cancer 2009. © 2009 American Cancer Society.

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