Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
Value Health. 2011 Mar-Apr;14(2):247-52. doi: 10.1016/j.jval.2010.09.005.
We examined health care use in conjunction with primary prophylaxis use of colony stimulating factors (CSF) during patients' initial course of chemotherapy.
This retrospective cohort study identified adults aged 25 years and older with a diagnosis of breast, colorectal, or nonsmall cell lung cancer between 2002 and 2005 from the Western Washington Surveillance Epidemiology and End Results Puget Sound registry. We linked these records to health insurance claims from four payers representing 75% of those insured in the state. Claims records were used to determine chemotherapy regimen type, CSF use, febrile neutropenia occurrences, and supportive care. Chemotherapy regimens were categorized as conferring high, intermediate, or low risk of myelosuppression according to the National Comprehensive Cancer Network guidelines. CSF use was described as primary prophylaxis, other, or none. Antibiotics and antifungal and antiviral agents per National Comprehensive Cancer Network guidelines for supportive care for cancer infection were categorized using Healthcare Common Procedure Coding System and National Drug Code assignments.
Use of CSF as primary prophylaxis is not significantly associated with a reduction in antibiotic use or inpatient or outpatient visits. Primary prophylactic CSF use was associated with less use of antiviral drugs.
CSF use is not associated with a reduction in health care use, with the exception of antiviral drug use. Given the expense associated with CSF use, pragmatic trials and additional research are needed to further assess the affects of CSF on health care use.
我们研究了患者化疗初始阶段集落刺激因子（CSF）的一级预防使用与医疗保健利用之间的关系。
这项回顾性队列研究从华盛顿西部监测、流行病学和结果普查注册中心（Western Washington Surveillance Epidemiology and End Results Puget Sound registry）确定了 2002 年至 2005 年间被诊断患有乳腺癌、结直肠癌或非小细胞肺癌的 25 岁及以上成年人。我们将这些记录与来自四家保险公司的健康保险索赔记录进行了关联，这些保险公司代表了该州 75%的参保人。索赔记录用于确定化疗方案类型、CSF 使用、发热性中性粒细胞减少症发生情况以及支持性护理。根据国家综合癌症网络指南，将化疗方案分为高、中、低骨髓抑制风险。CSF 使用被描述为一级预防、其他或无。根据国家综合癌症网络指南，使用医疗保健通用程序编码系统和国家药物代码分配来分类支持癌症感染的抗生素和抗真菌及抗病毒药物。
一级预防使用 CSF 与抗生素使用减少或住院或门诊就诊减少无关。一级预防性 CSF 使用与抗病毒药物使用减少相关。
除了抗病毒药物的使用外，CSF 的使用与医疗保健使用的减少无关。鉴于 CSF 使用的费用，需要进行务实的试验和进一步的研究，以进一步评估 CSF 对医疗保健使用的影响。
