Economic evaluation of recombinant human granulocyte colony-stimulating factor in very high-risk childhood acute lymphoblastic leukemia
| Autor: | Stéphanie Badin, Yves Perel, Thierry Leblanc, Christian Berthou, Anne-Gaelle G Le Corroller, Jean-Pierre Lamagnere, Guy Leverger, Diane Braguer, Jean-Pierre Vannier, François Demeocq, André Baruchel, Gérard Michel, Virginie Gandemer, Jean Delorme, Pierre Bordigoni, Anne Auvrignon, Marie-Françoise Auclerc, Brigitte Pautard, François Bauduer |
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| Rok vydání: | 2003 |
| Předmět: |
Male
medicine.medical_specialty Neutropenia Cost-Benefit Analysis Disease-Free Survival law.invention Cohort Studies Randomized controlled trial law Risk Factors Internal medicine Antineoplastic Combined Chemotherapy Protocols Granulocyte Colony-Stimulating Factor medicine Humans Economics Pharmaceutical Child Childhood Acute Lymphoblastic Leukemia health care economics and organizations business.industry Palliative Care Infant Newborn Infant Hematology Precursor Cell Lymphoblastic Leukemia-Lymphoma Recombinant Proteins Surgery Granulocyte colony-stimulating factor Regimen Platelet transfusion Treatment Outcome Oncology Pediatrics Perinatology and Child Health Chemoprophylaxis Cohort Female business Cohort study |
| Zdroj: | Journal of pediatric hematology/oncology. 25(6) |
| ISSN: | 1077-4114 |
| Popis: | PURPOSE In a previous randomized study, the authors reported that granulocyte colony-stimulating factor (G-CSF) increased the chemotherapy dose-intensity delivered during the consolidation therapy of high-risk childhood acute lymphoblastic leukemia (ALL). The aim of the current study was to perform an economic evaluation in the same cohort. METHODS In this open-label multicenter randomized trial, prophylactic G-CSF was administered after consolidation therapy courses. Economic data were retrospectively quantified for each patient: hospital stays, drugs, and blood products. RESULTS Sixty-seven children were enrolled in the very high-risk branch of the FRALLE 93 protocol. Chemotherapy dose-intensity was significantly increased (105 +/- 5% in the G-CSF group vs. 91 +/- 4% in the non-G-CSF group, P < 0.001). The mean total costs per child were not statistically different: 32,309 dollars in the G-CSF group versus 31,569 dollars in the non-G-CSF group. Further analysis per child and per course (R3 or COPADM) demonstrated that the mean cost of hospitalization and the mean cost of intravenous antibiotics were significantly decreased in the G-CSF group after R3 courses (3,857 dollars vs. 4,993.80 dollars, P < 0.001; 171.40 dollars vs. 306.20 dollars, P = 0.029, respectively), but the cost of platelet transfusion was significantly increased (P = 0.03). Conversely, post-COPADM costs were similar. Finally, mean costs per course in the two randomized groups were not significantly different: 5,848.80 dollars versus 6,181 dollars and 7,388.10 dollars versus 6,475.70 dollars for R3 and COPADM, respectively. The 3-year probability of event-free survival between the two groups was not different. CONCLUSIONS G-CSF can increase chemotherapy dose-intensity in very high-risk ALL without raising costs, but event-free survival was not improved. The cost benefit of prophylactic treatment by G-CSF relies on the chemotherapeutic regimen given prior to G-CSF administration. |
| Databáze: | OpenAIRE |
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