Bennett C L, Stinson T J, Lane D, Amylon M, Land V J, Laver J H
Chicago VA Healthcare System-Lakeside, Chicago, Illinois 60611, USA.
Med Pediatr Oncol. 2000 Feb;34(2):92-6. doi: 10.1002/(sici)1096-911x(200002)34:2<92::aid-mpo3>3.0.co;2-q.
Growth factor use has been shown to ameliorate chemotherapy-induced neutropenia, leading to shorter hospital stays and lower use of parenteral antibiotics, two costly areas of cancer treatment. Prior reports on pediatric patients have shown evidence of cost savings in some studies, but no such evidence in others. In this study a retrospective analysis compared the costs of inpatient supportive care for pediatric patients with T-cell leukemia and advanced lymphoblastic lymphoma enrolled in a Pediatric Oncology Group trial.
Patients 1-22 years of age were randomized to receive either granulocyte colony-stimulating factor (G-CSF; n = 45) or no G-CSF (n = 43) following induction and two cycles of maintenance therapy. There were no significant differences in neutropenia-related outcomes during the induction phase. During maintenance therapy, G-CSF patients had significantly fewer days to an ANC >500 cells/microl and a trend towards fewer days of hospitalization. Data on resource utilization were tabulated from case report forms. Costs were imputed from national data on hospitalization costs, average wholesale prices of pharmaceuticals, and patient billing information from a single institution.
Total median costs of supportive care were $34,190 for patients receiving G-CSF and $28,653 for patients not receiving G-CSF (P > 0. 05 for the cost difference). Sensitivity analyses demonstrated that the total cost difference was not statistically significant, even in scenarios that included reasonable variations in estimates of the range of the length of stay, antibiotic regimen, and dosage and cost of G-CSF.
In the setting of pediatric leukemia, the cost of growth factor may offset potential savings from shorter hospital stays or lower antibiotic use, a finding consistent with that from the Children's Cancer Study Group.
生长因子的使用已被证明可改善化疗引起的中性粒细胞减少症，从而缩短住院时间并减少肠外抗生素的使用，这是癌症治疗中两个成本高昂的领域。先前关于儿科患者的报告在一些研究中显示了成本节约的证据，但在其他研究中则没有此类证据。在本研究中，一项回顾性分析比较了参加儿科肿瘤学组试验的T细胞白血病和晚期淋巴细胞淋巴瘤儿科患者的住院支持治疗成本。
1至22岁的患者在诱导和两个周期的维持治疗后被随机分配接受粒细胞集落刺激因子（G-CSF；n = 45）或不接受G-CSF（n = 43）。诱导期中性粒细胞减少相关结局无显著差异。在维持治疗期间，接受G-CSF的患者达到绝对中性粒细胞计数>500个细胞/微升的天数显著减少，住院天数有减少的趋势。资源利用数据从病例报告表中列出。成本根据国家住院成本数据、药品平均批发价格以及单个机构的患者计费信息估算得出。
接受G-CSF的患者支持治疗的总中位成本为34,190美元，未接受G-CSF的患者为28,653美元（成本差异P>0.05）。敏感性分析表明，即使在住院时间、抗生素方案以及G-CSF剂量和成本估计范围存在合理变化的情况下，总成本差异也无统计学意义。
在儿科白血病的情况下，生长因子的成本可能抵消因缩短住院时间或减少抗生素使用而可能节省的费用，这一发现与儿童癌症研究组的结果一致。
