Comparative effectiveness of pegfilgrastim, filgrastim, and sargramostim prophylaxis for neutropenia-related hospitalization: two US retrospective claims analyses

Abstract

Objective:

Few studies have compared the effectiveness of filgrastim (FIL), pegfilgrastim (PEG), and sargramostim (SAR) to reduce the risk of febrile neutropenia (FN) associated with myelosuppressive chemotherapy (M-CT). Two large commercial database analyses were separately conducted to examine the incidence of neutropenia-related and all-cause hospitalizations associated with FIL, PEG, and SAR prophylaxis for patients receiving M-CT for non-Hodgkin lymphoma (NHL), Hodgkin lymphoma, or solid tumors.

Methods:

Separate retrospective US claims database analyses utilized patient data from January 1, 2004 to April 30, 2010 using the HealthCore Integrated Research Database (HIRD^SM) and January 1, 2001 to August 31, 2009 using OptumInsight’s (formerly Ingenix) database. Patients were ≥18 years old and treated with M-CT for NHL, Hodgkin lymphoma, and solid tumors. All identified M-CT cycles with prophylactic (first 5 days of cycle) FIL, PEG, or SAR were included in the analysis. Patterns of administration and incidence rates of all-cause and neutropenia-related hospitalization were examined on a per-cycle basis.

Results:

In total, 9330 and 8762 patients with cancer, representing 30,264 and 24,215 chemotherapy cycles (28,189 and 22,649 (PEG), 1669 and 1351 (FIL), 406 and 215 (SAR)) from the HIRD^SM and OptumInsight databases, respectively, were included in the separate database analyses. Both the HIRD^SM and OptumInsight analysis showed that SAR and FIL prophylaxis had a higher risk of neutropenia-related hospitalization (SAR: OR = 3.48 [95%CI = 2.11, 5.74] and 2.81 [1.62, 4.87]; FIL: 1.78 [1.28, 2.48] and 2.36 [1.82, 3.06], respectively) and all-cause hospitalization (SAR: 2.18 [1.41, 3.36] and 2.41 [1.58, 3.68]; FIL:1.57 [1.25, 1.97] and 1.95 [1.60, 2.38], respectively) vs PEG.

Limitations:

Medical claims do not contain information about chemotherapy dose, and hospitalizations were not validated against the patient’s chart.

Conclusion:

In this comparative effectiveness study, use of PEG was associated with a lower risk of neutropenia-related and all-cause hospitalizations compared to use of FIL or SAR prophylaxis.

Keywords::

• Neutropenia
• Prophylaxis
• Colony-stimulating factor
• Outcomes
• Pegfilgrastim
• Filgrastim
• Sargramostim

Transparency

Declaration of funding

This study was funded by Amgen, Inc. Amgen sponsored the retrospective analysis of claims data from the HealthCore Integrated Research Database (HIRD^SM Wilmington, DE) and the OptumInsight (Eden Prairie, MN) claims database.

Declaration of financial/other relationships

H.T., J.Y., and A.K. as well as H.J.H. and L.B. have disclosed that they are employees of HealthCore, Inc. and OptumInsight, respectively, which provided consultancy for the project funded by Amgen. N.A. has declared grant funding from Genetech, as well as Amgen Speaker and Consultant services.

Acknowledgment

The authors would like to acknowledge the writing assistance of Tara Cowling, of Medlior Health Outcomes Ltd. These results were presented in part at the American Society of Clinical Oncology Annual Meeting, Chicago, IL, June 3–7, 2011.

Notes

*Study period was defined as the 1-year period prior to course start date (baseline) through end of course.

†Patients were excluded if they received their medication through pharmacy (as opposed to medical HCPCS codes), as the exact chemotherapy administration date cannot be determined, subsequently affecting their chemotherapy cycle logic based on claims.

*Like Weycker et al.²⁵, OptumInsight excluded patients with pharmacy claims for FIL and SAR from this calculation and therefore may have smaller sample sizes compared to HIRD^SM results which used pharmacy claims.

†FIL vs PEG adjusted odds ratio in OptumInsight data is not statistically significant, likely due to the low incidence of the outcome in its narrow definition. The use of the narrow definition may under-estimate the real FN incidence rate because of potential under-coding of neutropenia.