Frampton J E, Faulds D
Adis International Ltd, Auckland, New Zealand.
Pharmacoeconomics. 1996 Jan;9(1):76-96. doi: 10.2165/00019053-199609010-00008.
Neutropenia is a frequent and often dose-limiting complication of chemotherapy and is associated with considerable patient morbidity and mortality. Standard treatment in patients who become febrile includes hospitalisation and empirical antibiotic therapy. Filgrastim is a recombinant human granulocyte colony-stimulating factor (rHuG-CSF). It significantly decreases the incidence of febrile neutropenia in patients receiving standard-dose chemotherapy, and shortens the duration of febrile neutropenia in patients undergoing autologous bone marrow transplantation (BMT) or peripheral blood progenitor cell (PBPC) infusion after myeloablative chemotherapy regimens. These effects are usually associated with a decrease in hospitalisation and antibiotic requirements. The contribution of filgrastim therapy to beneficial effects on other clinically important end-points (e.g. quality of life, tumour relapse rate, and short and long term survival) remains to be accurately determined. Pharmacoeconomic data concerning the use of filgrastim as an adjunct to standard-dose chemotherapy are derived largely from the results of phase III trials. Cost analyses based on hospital charges suggest that the cost of providing filgrastim therapy can be fully recouped if the drug is used as primary prophylaxis in previously untreated patients, for whom the risk of developing febrile neutropenia is at least 40%. Reserving filgrastim for use in patients who have developed febrile neutropenia in a previous chemotherapy cycle may result in further cost savings. However, careful patient selection is required, since potential cost savings will vary depending upon the risk of hospitalisation in the absence of filgrastim treatment. Infusion of filgrastim-mobilised PBPCs is emerging as a preferred strategy in patients receiving myeloablative chemotherapy, and promising results have been obtained from cost analyses. From a pharmacoeconomic viewpoint, future research should be directed towards defining optimum dosage regimens and hence improving the cost-effective use of filgrastim. Data evaluating patient quality of life and treatment preferences would help define the cost utility of filgrastim therapy. In the meantime, available pharmacoeconomic data support the use of filgrastim as an adjunct to chemotherapy in selected clinical situations.
中性粒细胞减少是化疗常见且常限制剂量的并发症，与患者较高的发病率和死亡率相关。发热患者的标准治疗包括住院和经验性抗生素治疗。非格司亭是一种重组人粒细胞集落刺激因子（rHuG-CSF）。它能显著降低接受标准剂量化疗患者发热性中性粒细胞减少的发生率，并缩短接受自体骨髓移植（BMT）或清髓性化疗方案后进行外周血祖细胞（PBPC）输注患者的发热性中性粒细胞减少持续时间。这些作用通常与住院时间和抗生素需求的减少相关。非格司亭治疗对其他临床重要终点（如生活质量、肿瘤复发率以及短期和长期生存率）的有益影响仍有待准确确定。关于非格司亭作为标准剂量化疗辅助药物使用的药物经济学数据主要来自III期试验结果。基于医院收费的成本分析表明，如果将该药物用于先前未治疗且发生发热性中性粒细胞减少风险至少为40%的患者作为主要预防措施，提供非格司亭治疗的成本可以完全收回。将非格司亭留作在前一化疗周期已发生发热性中性粒细胞减少的患者使用可能会进一步节省成本。然而，需要仔细选择患者，因为在不使用非格司亭治疗时潜在的成本节省会因住院风险而异。输注非格司亭动员的PBPC正在成为接受清髓性化疗患者的首选策略，并且成本分析已取得了有前景的结果。从药物经济学角度来看，未来的研究应致力于确定最佳剂量方案，从而提高非格司亭的成本效益。评估患者生活质量和治疗偏好的数据将有助于确定非格司亭治疗的成本效用。与此同时，现有的药物经济学数据支持在特定临床情况下将非格司亭作为化疗辅助药物使用。
