, Volume 11, Issue 6, pp 566–577 | Cite as

Cost-Benefit Analysis of Prophylactic Granulocyte Colony-Stimulating Factor During CHOP Antineoplastic Therapy for Non-Hodgkin’s Lymphoma

  • George Dranitsaris
  • Christopher Altmayer
  • Ian Quirt
Original Research Article


Several randomised comparative trials have shown that granulocyte colony-stimulating factor (G-CSF) reduces the duration of neutropenia, hospitalisation and intravenous antibacterial use in patients with cancer who are receiving high-dosage antineoplastic therapy. However, one area that has received less attention is the role of G-CSF in standard-dosage antineoplastic regimens. One such treatment that is considered to have a low potential for inducing fever and neutropenia is the CHOP regimen (cyclophosphamide, doxorubicin, vincristine and prednisone) for non-Hodgkin’s lymphoma.

We conducted a cost-benefit analysis from a societal perspective in order to estimate the net cost or benefit of prophylactic G-CSF in this patient population. This included direct costs for hospitalisation with antibacterial support, as well as indirect societal costs, such as time off work and antineoplastic therapy delays secondary to neutropenia. The findings were then tested by a comprehensive sensitivity analysis.

The administration of G-CSF at a dosage of 5 µg/kg/day for 11 doses following CHOP resulted in an overall net cost of $Can1257. In the sensitivity analysis, lowering the G-CSF dosage to 2 µg/kg/day generated a net benefit of $Can6564, indicating a situation that was cost saving to society.

The results of the current study suggest that the use of G-CSF in patients receiving CHOP antineoplastic therapy produces a situation that is close to achieving cost neutrality. However, low-dosage (2 µg/kg/day) G-CSF is an economically attractive treatment strategy because it may result in overall savings to society.


Febrile Neutropenia Antineoplastic Therapy Neutropenic Fever Princess Margaret Hospital Plastic Therapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    American Cancer Society. Cancer facts and figures. New York: American Cancer Society, 1995: 14Google Scholar
  2. 2.
    Silverberg E, Boring CC, Squires T. Cancer Statistics 1990. CA-AJ Clinicians 1990; 50: 9–26CrossRefGoogle Scholar
  3. 3.
    Weisenburger DD. Epidemiology of non-Hodgkin’s lymphoma: recent findings regarding an emerging epidemic. Ann Oncol 1994; 5 Suppl. 1: 19–24PubMedCrossRefGoogle Scholar
  4. 4.
    DeVita Jr VT, Canellos GP, Chabner B, et al. Advanced diffuse histiocytic lymphoma, a potentially curable disease. Lancet 1975; I: 248–50CrossRefGoogle Scholar
  5. 5.
    Gordon LI, Harrington D, Anderson J, et al. Comparison of a second-generation combination chemotherapeutic regimen (m-BACOD) with a standard regimen (CHOP) for advanced diffuse non-Hodgkin’s lymphoma. N Engl J Med 1992: 327: 1342–9PubMedCrossRefGoogle Scholar
  6. 6.
    Fisher RI, Gaynor ER, Dahlberg S, et al. Comparison of a standard regimen (CHOP) with three intensive chemotherapy regimens for advanced non-Hodgkin’s lymphoma. N Engl J Med 1993: 328: 1002–6PubMedCrossRefGoogle Scholar
  7. 7.
    Hollingshead LM, Goa KL. Recombinant granulocyte colony-stimulating factor (rG-CSF): a review of its pharmacological properties and prospective role in neutropenic conditions. Drugs 1991; 42: 300–30PubMedCrossRefGoogle Scholar
  8. 8.
    Gabrilove JL, Jakubowski A, Scher H, et al. Effect of granulocyte colony-stimulating factor on neutropenia and associated morbidity due to chemotherapy for transitional-cell carcinoma of the urothelium. N Engl J Med 1988; 318: 1414–22PubMedCrossRefGoogle Scholar
  9. 9.
    Dranitsaris G, Sutcliffe SB. Economic analysis of prophylactic G-CSF after mini-BEAM salvage chemotherapy for Hodgkin’s and non-Hodgkin’s lymphoma. Leuk Lymphoma 1995; 17: 139–45PubMedCrossRefGoogle Scholar
  10. 10.
    Crawford J, Ozer H, Stoller R, et al. Reduction by granulocyte colony-stimulating factor of fever and neutropenia induced by chemotherapy in patients with small-cell lung cancer. N Engl J Med 1991; 325: 164–70PubMedCrossRefGoogle Scholar
  11. 11.
    Stahel RA, Jost LM, Cerny T, et al. Randomized study of recombinant human granulocyte colony-stimulating factor after high-dose chemotherapy and autologous bone marrow transplantation for high-risk lymphoid malignancies. J Clin Oncol 1994; 12: 1931–38PubMedGoogle Scholar
  12. 12.
    Sheridan WP, Wolf M, Lusk J, et al. Granulocyte colony-stimulating factor and neutrophil recovery after high-dose chemotherapy and autologous bone marrow transplantation. Lancet 1989; 14: 891–5CrossRefGoogle Scholar
  13. 13.
    Lyman GH, Lyman CG, Sanderson RA, et al. Decision analysis of hematopoietic growth factor use in patients receiving cancer chemotherapy. J Natl Cancer Inst 1993; 85: 488–93PubMedCrossRefGoogle Scholar
  14. 14.
    Longo DL, De Vita Jr VT, Jaffe ES, et al. Lymphocytic lymphomas. In: De Vita VT, Hellman S, Rosenberg SA, editors. Cancer principles and practice of oncology. 4th ed. Philadelphia (PA): JB Lippincott, 1989: 1859–1927Google Scholar
  15. 15.
    Torrance GW, Blaker D, Detsky A, et al. Canadian guidelines for economic evaluation of pharmaceuticals. Pharmacoeconomics 1996; 9: 535–59PubMedCrossRefGoogle Scholar
  16. 16.
    Silvestri F, Velisig M, Fanin R, et al. Granulocyte colony-stimulating factor (G-CSF) allows the delivery of effective doses of CHOP and CVP regimens in non-Hodgkin’s lymphomas. Leuk Lymphoma 1995; 16: 465–70PubMedCrossRefGoogle Scholar
  17. 17.
    Guyatt GH, Sackett DL, Cook DJ. Users’ guides to the medical literature: how to use an article about therapy or prevention. JAMA 1994; 271: 59–63PubMedCrossRefGoogle Scholar
  18. 18.
    Toner GC, Laidlaw C, Millward MJ, et al. Low versus standard dose prophylactic G-CSF after chemotherapy: a randomized crossover comparison [abstract]. Blood 1994; 10 Suppl. 1: 84Google Scholar
  19. 19.
    Tanosaki R, Okamato S, Akatsuka N, et al. Dose escalation of biweekly cyclophosphamide, doxorubicin, vincristine, and prednisone using recombinant human granulocyte colony stimulating factor in non-Hodgkin’s lymphoma. Cancer 1994; 74: 1939–44PubMedCrossRefGoogle Scholar
  20. 20.
    Zinzani PL, Martelli M, Tura S, et al. Granulocyte colony stimulating factor (G-CSF) as adjunct therapy in relapsed-resistant high-grade non-Hodgkin’s lymphoma. Haematologica 1993; 78: 40–3PubMedGoogle Scholar
  21. 21.
    Kuni-Eda Y, Okabe M, Kurosawa M, et al. Effects of rhG-CSF on infection complications and impaired function of neutrophils secondary to chemotherapy for non-Hodgkin’s lymphoma. Leuk Lymphoma 1995; 16: 471–6PubMedCrossRefGoogle Scholar
  22. 22.
    Masson E, Gregroire JP, Dupont N, et al. Cost analysis of febrile neutropenic episodes following cancer chemotherapy: a descriptive study in Canada. Can J Clin Pharmacol 1995; 2: 70–6Google Scholar
  23. 23.
    Fazio MT, Glaspy JA. The impact of granulocyte colony stimulating factor on quality of life in patients with severe chronic neutropenia. Oncol Nurs Forum 1991; 18: 1411–4PubMedGoogle Scholar
  24. 24.
    Lepage E, Gisselbrecht C, Sebban HC, et al. Prognostic significance of received relative dose intensity in non-Hodgkin’s lymphoma patients: application to LNH-87 protocol. Ann Oncol 1993; 4: 651–6PubMedGoogle Scholar
  25. 25.
    van Rijswijk REN, Haanen C, Dekker AW, et al. Dose intensity of MOPP chemotherapy and survival in Hodgkin’s Disease. J Clin Oncol 1989; 7: 1776–82PubMedGoogle Scholar
  26. 26.
    Pettengell R, Gurney H, Radford JA, et al. Granulocyte colony-stimulating factor to prevent dose-limiting neutropenia in non-Hodgkin’s lymphoma: a randomized controlled trial. Blood 1992; 80: 1430–6PubMedGoogle Scholar
  27. 27.
    Mayer RM, Hryniuk WM, Goodyear MDE. The role of dose intensity in determining outcome in intermediate-grade non-Hodgkin’s lymphoma. J Clin Oncol 1991; 9: 339–47Google Scholar
  28. 28.
    Posnett J, Jan S. Indirect cost in economic evaluations: the opportunity cost of unpaid inputs. Health Econ 1996; 5: 13–23PubMedCrossRefGoogle Scholar
  29. 29.
    D’Antonio D, Piccolomini R, Iacone A, et al. Comparison of ciprofloxacin, ofloxacin and pefloxacin for the prevention of bacterial infection in neutropenic patients with haematological malignancies. J Antimicrob Chemother 1994; 33: 837–44PubMedCrossRefGoogle Scholar
  30. 30.
    Dennig D, Fulle HH, Hellriegel KP. Chemoprophylaxis of bacterial infections in granulocytopenic patients with ciprofloxacin. Onkologie 1987; 10: 57–8PubMedCrossRefGoogle Scholar
  31. 31.
    Carlson JW, Fowler JM, Saltzman AK, et al. Chemoprophylaxis with oral ciprofloxacin in ovarian cancer patients receiving Taxol. Gynecol Oncol 1994; 55: 415–20PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 1997

Authors and Affiliations

  • George Dranitsaris
    • 1
  • Christopher Altmayer
    • 1
  • Ian Quirt
    • 2
  1. 1.Department of PharmacyOntario Cancer Institute/Princess Margaret HospitalTorontoCanada
  2. 2.Department of Medical OncologyOntario Cancer Institute/Princess Margaret HospitalTorontoCanada

Personalised recommendations