Cost Effectiveness of G:CSF in Chemotherapy and Transplant-related Neutropenia

Abstract

Sustained fever over 38°C is potentially lethal when neutrophil counts remain below 0.1 × 10⁹/L. To determine whether the addition of a haematopoietic stimulatory peptide to conventional supportive care and antibiotic management was cost-effective, 74 such episodes were analysed. Group I (5μg/kg G: CSF: n = 41); Group II (10 μg/kg: n = 19) and Group III (controls: n = 14): these were similar in respect of race, gender, age and body weight. The median days and range of neutrophil count below 0.1 × 10⁹/Lw as 6 (0–12), 7 (0–20) and 8 (0–20) and the corresponding figures for 0.5 × 10⁹/L were 8 (0–19), 8 (1–23) and 13.5 (3–30) days respectively, while the median hospital period was 26 (18–49), 30 (9–86) and 35 (13–44). Mean, standard deviation and range for bed costs in Group I was R9,528 (2125:6120–1660), the corresponding figures for Group II were Rll,453 (5570:3060–2924), and for Group III Rll,366 (2755: 4420–1496). The approximate fate of exchange is: Rl = US$5.87. When expenditure for growth factor was integrated these figures were approximately R26,071, R37,787 and R27,376. There were no advantages in 10 over 5 μg/kg G: CSF. More red cell transfusions were needed in Group III. The days requiring antimicrobial therapy were 14, 16 and 20 respectively. It is concluded from this study, carried out in reverse isolation at a University Teaching Hospital, that duration of neutropenic fever was significantly shortened on G: CSF but there was no benefit in using the higher dose. Additionally, at equivalent cost, there was a shorter period of hospitalisation thereby reducing risk of acquiring nosocomial infections. Finally, there was concurrently a decreased exposure to potentially nephrotoxic antibiotics. Accordingly, this regimen can be justified in the routine management of this category of patient.

Keywords:

• Neutropenic sepsis
• G:CSF administrations
• hospitalization period
• nephrotoxic antibiotics