Management and cost analysis of cancer patients treated with G-CSF: a cohort study based on the French national healthcare insurance database

Figures & data

Table 1. Patients characteristics and G-CSF product according to cancer type.

	Breast cancer (n = 375)	Hematological malignancy^b (n = 358)	Lung cancer (n = 201)	Colorectal cancer (n = 95)	Other solid tumors^c (n = 583)	Total patients included (n = 1,612)	p
Men, %	1.1	53	67	59	57	44.5	<.0001
Age (years), mean (SD)	56.6 (12.4)	64.0 (16.6)	63.9 (9.3)	64.7 (11.4)	63.0 (13.7)	62 (14)	<.0001
Died in 2013/2014, n (%)	31 (8.3%)	63 (17.6%)	98 (48.8%)	25 (26.3%)	219 (37.6%)	27.0	<.0001
G-CSF product^a, %
Filgrastim	17	49	30	38	31	32	<.0001
Lenograstim	33	49	38	57	43	42	<.0001
Pegfilgrastim	66	36	54	26	47	49	<.0001
Interval between chemotherapy cures ≥18 days, %	83	67	68	50	61	68	<.0001

^a At least one G-CSF product during the study period (the total of the column can exceed 100%).

^b Hodgkin lymphoma = 35, Other lymphoma = 187, multiple myeloma = 70, lymphoid leukemia = 49, myeloid leukemia = 15, others = 2.

^c Other solid tumors: Female genital organs = 80, Male genital organ = 52, Urinary tract = 32, Head and Neck = 37, Other digestive cancer = 109, other localization = 47, and two simultaneous cancer diagnoses = 226.

SD, standard deviation.

Table 2. Treatment costs reimbursed by the French national healthcare insurance for cancer patients according to the main types of cancer (€).

Mean; Median (Q1–Q3)	Breast cancer (n = 375)	Hematological malignancy (n = 358)	Lung cancer (n = 201)	Colorectal cancer (n = 95)	Other cancer (n = 583)	Total (n = 1,612)	p
Medical fees	€810; 434 (201–999)	€341; 165 (46–391)	€899; 373 (117–1,002)	€728; 449 (203–933)	€761; 358 (131–773)	€695; 326 (115–760)	<.0001
Pharmacy and derived products^a	€791; 375 (158–812)	€5,126; 1,030 (223–3,232)	€1,885; 1,006 (365–2,410)	€1,793; 891 (504–2,436)	€1,950; 864 (311–2,166)	€2,368; 679 (236–2,047)	<.0001
G-CSF^b	€3,017; 2,947 (1,487–4;017)	€2,904; 2,158 (1,173–3,964)	€2,487; 1,964 (982–3,748)	€2,654; 1,486 (793–3,447)	€2,589; 1,964 (982–3,509)	€2,750; 2,033 (982–3,929)	<.0001
Ambulatory cancer treatment	€1,143; 104 (0–829)	€397; 0 (0–19)	€1,485; 0 (0–0)	€461; 0 (0–0)	€1,327; 0 (0–0)	€1,046; 0 (0–167)	<.0001
Nursing care	€357; 143 (51–354)	€411; 156 (51–385)	€691; 236 (67–614)	€992; 472 (204–1;225)	€884; 262 (90–782)	€639; 209 (68–561)	<.0001
Laboratory tests	€154; 61 (7–207)	€262; 182 (67–367)	€278; 180 (61–400)	€374; 295 (168–541)	€268; 191 (65–388)	€248; 159 (45–346)	<.0001
Medical devices, dressings, etc.	€226; 94 (2–167)	€205; 27 (0–149)	€546; 120 (4–325)	€1,111; 617 (295–1,123)	€841; 164 (16–730)	€536; 114 (2–375)	<.0001
Transport	€1,132; 462 (69–1,534)	€901; 305 (0–1,038)	€1,341; 641 (80–1,916)	€1,282; 451 (64–1,455)	€1,154; 440 (63–1,427)	€1,124; 443 (51–1,429)	0.0093
Miscellaneous (dentist fees, etc.)	€15; 0 (0–0)	€11; 0 (0–0)	€12; 0 (0–0)	€15; 0 (0–0)	€10; 0 (0–0)	€12; 0 (0–0)	0.0003
1. Total cost of ambulatory care	€7,645; 6,542 (4,147–9,028)	€10,558; 6,440 (3,703–10,504)	€9,624; 8,399 (4,152–12,541)	€9,410; 7,474 (4,468–12,961)	€9,783; 7,290 (3,835–12,303)	€9,416; 6,918 (3,983–10,889)	0.0190
2. Total cost of hospital care (including day care hospital)	€9,176;6,717 (4,440–10,888)	€24,080; 16,364 (8,312–28,304)	€14,582; 12,001 (7,190–19,898)	€15,834; 13,785 (7,754–19,482)	€15,199; 11,203 (5,607–20,296)	€15,730; 10,839 (5,569–19,993)	<.0001
(1 + 2) Total cost	€16,821; 13,826 (10,088–19,058)	€34,638; 24,977 (14,906–43,552)	€24,206; 22,242 (14,504–30,789)	€25,244; 22,256 (15,564–30,765)	€24,981; 20,918 (13,104–33,450)	€25,147; 19,384 (12,135–31,693)	<.0001

^a Pharmacy expenses excluded G-CSF and oral chemotherapy.

^b The part of G-CSF in the total cost of ambulatory care was 39% for breast cancer, 27% for hematological malignancies, 26% for lung cancer, and 28% for colorectal cancer.

Q1 = 25% quartile/Q3 = 75% quartile.

Table 3. Treatment costs reimbursed by the French national healthcare insurance for cancer patients according to the type of G-CSF (€).

Mean; Median (Q1–Q3)	Filgrastim (n = 288)	%	Lenograstim (n = 431)	%	Pegfilgrastim (n = 550)	%	Combined G-CSF (n = 343)	%	p
Medical fees	€640; 285 (96–739)	6.7%	€762; 353 (113–801)	8.2%	€694; 313 (133–742)	8.1%	€655; 348 (147–727)	6.0%	.6833
Pharmacy and derived products^a	€3,556; 1,041 (388–2,782)	37.4%	€2,588; 653 (194–2,099)	27.7%	€1,295; 465 (171–1,307)	15.2%	€2,815; 1,005 (359–2,626)	26.0%	<.0001
G-CSF^b	€1,801; 1,336 (610–2,434)	18.9%	€1,591; 1,189 (531–2,081)	17.0%	€3,723; 2,947 (1,964–4,911)	43.7%	€3,441; 3,016 (1,801–4,527)	31.7%	<.0001
Ambulatory cancer treatment	€836; 0 (0–26)	8.8%	€1,501; 0 (0–235)	16.1%	€835; 0 (0–226)	9.8%	€990; 0 (0–104)	9.1%	.0537
Nursing care	€671; 256 (96–702)	7.1%	€740; 271 (95–627)	7.9%	€447; 114 (40–346)	5.2%	€791; 270 (110–646)	7.3%	<.0001
Laboratory tests	€277; 191 (68–380)	2.9%	€275; 194 (62–393)	2.9%	€170; 86 (17–215)	2.0%	€312; 258 (98–453)	2.9%	<.0001
Medical devices, dressings, etc.	€601;115 (0–474)	6.3%	€647; 125 (5–422)	6.9%	€376; 88 (0–275)	4.4%	€596; 118 (7–431)	5.5%	.0956
Transport	€1,121; 518 (69–1,401)	11.8%	€1,228; 433 (28–1,513)	13.1%	€983; 352 (50–1,216)	11.5%	€1,219; 534 (76–1,492)	11.3%	.3415
Miscellaneous (dentist fees, etc.)	€9; 0 (0–0)	0.1%	€12; 0 (0–0)	0.2%	€11; 0 (0–0)	0.1%	€17; 0 (0–0)	0.2%	.0210
1. Total cost of ambulatory care	€9,512; 6,230 (3,389–10,718)	35.2%	€9,344; 6,089 (3,162–10,463)	38.1%	€8,534; 7,151 (4,450–10,504)	41.0%	€10,836; 7,827 (4,862–13,185)	38.1%	<.0001
2. Total cost of hospital care (including day care hospital)	€17,489; 12,070 (6,497–23,149)	64.8%	€15,167; 10,696 (5,721–18,751)	61.9%	€12,268; 8,560 (4,650–16,108)	59.0%	€20,514; 14,957 (7,910–27,936)	61.9%	<.0001
(1 + 2) Total cost	€27,002; 20,926 (12,406–35,308)	100%	€24,511; 18,564 (11,568–29,083)	100%	€20,802; 16,991 (11,133–26,347)	100%	€31,350; 24,741 (15,988–39,470)	100%	<.0001

^a Pharmacy expenses excluding G-CSF and ambulatory cancer treatment; the part of pharmacy in total ambulatory costs was 37% for filgrastim, 28% for lenograstim, and 15% for pegfilgrastim.

^b The part of G-CSF in the total cost of ambulatory care was 19% for filgrastim, 17% for lenograstim, and 44% for pegfilgrastim.

Q1 = 25% quartile/Q3 = 75% quartile.

Table 4. Patient characteristics, G-CSF, and reimbursements (€) by the French national healthcare insurance for patients with breast cancer (n = 375).

	Filgrastim (n = 33)	Lenograstim (n = 82)	Pegfilgrastim (n = 200)	Combined G-CSF (n = 60)	p
Age (years), mean (SD)	60.6 (11.9)	56.7 (12.7)	56.4 (11.5)	54.3 (14.8)	.14
Died during the study period, n (%)	5 (15.2%)	9 (11.0%)	4 (2.0%)	13 (21.7%)	<.0001
Hospital care (all): n (%)					.0829
private sector	8 (25.0%)	21 (25.9%)	76 (38.0%)	12 (20.0%)
public sector	14 (43.8%)	36 (44.4%)	80 (40.0%)	26 (43.3%)
both sectors	10 (31.3%)	24 (29.6%)	44 (22.0%)	22 (36.7%)
At least one hospital admission, n (%)	31 (93.4%)	78 (95.1%)	189 (94.5%)	57 (95.0%)	.9927
Number of day-care hospitalizations during the year, mean (SD)	17.7 (14.4)	19.1 (14.4)	15.9 (14.9)	19.8 (14.1)	.1998
Total hospital stay (days) during the year, mean (SD)	4.6 (6.8)	3.3 (3.6)	2.3 (2.2)	3.6 (5.3)	.0737
Total number of G-CSF units at each dispensing date, mean (SD)	4.4 (1.6)	4.4 (1.4)	1.0 (0.2)	3.0 (1.4)	<.0001
Estimated duration of G-CSF treatment (days), mean (SD)	18.5 (13.6)	19.3 (23.1)	43.9 (19.2)	46.0 (33.2)	<.0001
Medical fees, mean; median (Q1–Q3)	€963; 685 (349–999)	€1,002; 574 (217–1,145)	€725; 339 (183–804)	€745; 534 (294–1,074)	.0219
Pharmacy and derivatives, mean; median (Q1–Q3)^a	€913; 479 (222–778)	€887; 431 (168–1,022)	€532; 282 (123–562)	€1,452; 621 (236–2,093)	<.0001
G-CSF, mean; median (Q1–Q3)	€1,733; 2,004 (573–2,542)	€1,559; 1,387 (595–1,982)	€3,668; 3,929 (2,456–4,911)	€3,549; 3,396 (2,047–4,847)	<.0001
Oral chemotherapy, mean; median (Q1–Q3)	€1,681; 121 (0–535)	€1,870; 151 (13–1,096)	€572; 52 (0–596)	€1,758; 111 (0–774)	.0646
Nursing care, mean; median (Q1–Q3)	€453; 255 (84–421)	€502; 261 (106–568)	€246; 82 (33–216)	€479; 205 (132–537)	<.0001
Laboratory tests, mean; median (Q1–Q3)	€193; 135 (31–242)	€204; 97 (17–291)	€91; 29 (0–115)	€272; 225 (36–414)	<.0001
Medical devices, dressings, mean; median (Q1–Q3)	€383; 105 (6–159)	€194; 125 (1–175)	€186; 80 (0–166)	€318; 70 (20–151)	.8995
Transport, mean; median (Q1–Q3)	€1,585; 1,247 (387–2,345)	€1,309; 711 (84–1,756)	€957; 367 (52–1,225)	€1,225; 446 (64–1,207)	.032
Others (dentist fees, etc.), mean; median (Q1–Q3)	€11; 0 (0–0)	€23; 0 (0–0)	€12; 0 (0–0)	€16; 0 (0–18)	.1196
(1) Total cost of ambulatory care, mean; median (Q1–Q3)	€7,915; 5,729 (4,514–7,258)	€7,550; 5,990 (3,316–9,214)	€6,990; 6,427 (4,501–8,835)	€9,814; 7,765 (4,714–12,051)	.022
(2) Total cost of hospital care, (including day care hospital) mean; median (Q1–Q3)	€12,106; 8,801 (5,197–15,798)	€10,748; 7,963 (5,021–12,478)	€7,673; 5,936 (3,960–9,485)	€10,425; 7,625 (4,826–11,791)	.0006
(1 + 2) Total cost, mean; median (Q1–Q3)	€20,021; 13,800 (11,299–21,396)	€18,298; 14,726 (10,958–21,804)	€14,663; 12,737 (9,584–17,486)	€20,238; 16;187 (10,745–25,852)	.0143
Interval between chemotherapy cures <18 days, n (%)	7 (22.6%)	16 (20.5%)	23 (12.1%)	16 (27.1%)	.0333

^a Pharmacy expenses excluding G-CSF and oral chemotherapy.

^bG-CSF represented 22% of total ambulatory care costs with filgrastim, 20% with lenograstim, 52% with pegfilgrastim, and 36% with combined G-CSF.

Q1 = 25% quartile/Q3 = 75% quartile.