Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston, TX 77030, USA.
Value Health. 2011 Mar-Apr;14(2):253-62. doi: 10.1016/j.jval.2010.09.010.
To determine the cost-effectiveness (as measured as cost per life-year saved) of white blood cell growth factor or colony-stimulating factor (CSF) use among a large cohort of elderly non-Hodgkin's lymphoma (NHL) patients in a real-world setting.
We identified 13,203 NHL patients from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database who received the diagnosis from 1992 to 2002 and who received chemotherapy within 12 months of diagnosis. Benefit (effectiveness) of CSF use (primary and secondary prophylaxis) was measured as observed improvement in overall survival. Costs for each patient were calculated by adding the cumulative reimbursement amounts from Medicare claims. Cost-effectiveness was estimated by modeling the joint influence of CSF use on both costs and effectiveness using a propensity-score net monetary benefit approach.
Primary prophylactic CSF use was cost-effective at lower willingness-to-pay thresholds, whereas at higher thresholds, not providing prophylactic CSF became the cost-effective strategy. For secondary prophylactic CSF use among patients experiencing neutropenia, fever, and/or infection, the opposite trend was observed. For low willingness-to-pay thresholds (<$20,000 per life-year gained), not administering CSF was the cost-effective strategy, whereas CSF use became cost-effective as willingness to pay increased (from $100,000+ per life-year gained).
To our knowledge, this is the first large population-based study to empirically measure the cost-effectiveness of CSF among NHL patients treated with chemotherapy. CSF use as primary or secondary prophylaxis may be a cost-effective strategy depending on society's (or payers') willingness to pay for improvements in outcomes.
在真实环境下，通过对大量老年非霍奇金淋巴瘤（NHL）患者进行研究，确定白细胞生长因子或集落刺激因子（CSF）的使用在成本效益方面（以每挽救一年生命所需成本衡量）的效果。
我们从监测、流行病学和最终结果（SEER）-医疗保险数据库中确定了 13203 名 NHL 患者，这些患者于 1992 年至 2002 年间被诊断出患有 NHL，并在诊断后 12 个月内接受了化疗。CSF 使用（一级和二级预防）的效益（效果）通过观察到的总体生存率提高来衡量。每位患者的成本通过添加医疗保险索赔中的累计报销金额来计算。通过使用倾向评分净货币收益方法对 CSF 使用对成本和效果的联合影响进行建模，对成本效益进行估计。
在较低的支付意愿阈值下，初级预防 CSF 使用具有成本效益，而在较高的阈值下，不提供预防性 CSF 成为具有成本效益的策略。对于经历中性粒细胞减少症、发热和/或感染的患者进行二级预防 CSF 使用，观察到相反的趋势。对于较低的支付意愿阈值（每挽救一年生命的成本低于 20000 美元），不给予 CSF 是具有成本效益的策略，而随着支付意愿的增加（每挽救一年生命的成本超过 100000 美元），CSF 使用变得具有成本效益。
据我们所知，这是第一项大规模基于人群的研究，旨在通过对接受化疗的 NHL 患者进行实证测量 CSF 的成本效益。CSF 的使用作为一级或二级预防可能是一种具有成本效益的策略，具体取决于社会（或支付方）对改善结果的支付意愿。
