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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
- Source :
- Journal of Clinical Oncology, Journal of Clinical Oncology, American Society of Clinical Oncology, 1998, 16 (8), pp.2700-7, HAL, Journal of Clinical Oncology, 1998, 16 (8), pp.2700-7
- Publication Year :
- 1998
- Publisher :
- American Society of Clinical Oncology (ASCO), 1998.
-
Abstract
- PURPOSE The clinical indications and economic consequences of human granulocyte colony-stimulating factor (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 cost-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.
- Subjects :
- Oncology
MESH: Decision Trees
Cancer Research
medicine.medical_specialty
Lung Neoplasms
Neutropenia
MESH: Neutropenia
Cost-Benefit Analysis
Markov model
Small-cell carcinoma
03 medical and health sciences
0302 clinical medicine
MESH: Markov Chains
Internal medicine
Antineoplastic Combined Chemotherapy Protocols
Granulocyte Colony-Stimulating Factor
Humans
Medicine
030212 general & internal medicine
Carcinoma, Small Cell
Lung cancer
MESH: Humans
Leukopenia
business.industry
Medical record
Decision Trees
MESH: Carcinoma, Small Cell
medicine.disease
Markov Chains
MESH: Lung Neoplasms
3. Good health
Surgery
Granulocyte colony-stimulating factor
MESH: Antineoplastic Combined Chemotherapy Protocols
030220 oncology & carcinogenesis
MESH: Granulocyte Colony-Stimulating Factor
[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
medicine.symptom
business
Febrile neutropenia
MESH: Cost-Benefit Analysis
Subjects
Details
- ISSN :
- 15277755 and 0732183X
- Volume :
- 16
- Database :
- OpenAIRE
- Journal :
- Journal of Clinical Oncology
- Accession number :
- edsair.doi.dedup.....f33dfed4d276cf8c333ef9445bae4f88
- Full Text :
- https://doi.org/10.1200/jco.1998.16.8.2700