Cost-benefit of granulocyte colony-stimulating factor administration in older patients with non-Hodgkin's lymphoma treated with combination chemotherapy

V. Zagonel, R. Babare, M. C. Merola, R. Talamini, R. Lazzarini, U. Tirelli, A. Carbone, S. Monfardini

Research output: Contribution to journalArticle

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Abstract

Background: Older patients with non-Hodgkin's lymphoma (NHL) display a poorer response to chemotherapy and a significantly higher treatment-associated toxicity than do younger individuals. We investigated the potential clinical benefits and the cost-effectiveness of accelerated granulocyte recovery induced by recombinant granulocyte colony-stimulating factor (G-CSF) in patients with aggressive NHLs, aged 60-70 years, during treatment with a second-generation combination chemotherapy. Patients and methods: 12 consecutive patients (median age 66 years) treated with six to eight courses of CHVmP/ VB plus subcutaneous G-CSF (5 μg/kg/day) were compared with 11 consecutive subjects (median age 65 years) who received the same chemotherapy regimen without growth factor support. The two groups of patients were fully comparable as to the clinicopathologic features. A comparative analysis of treatment costs (including hospitalization, antimicrobial prophylaxis and therapy, supportive and diagnostic procedures, and G-CSF) was also performed. Results: Both the overall response rate and the percentage of complete remissions were comparable in the two treatment groups. In the control group, 32.5% of chemotherapy courses were delayed, as opposed to 19% in the G-CSF group (p = 0.05). The mean duration of delay for patients receiving or not receiving G-CSF was 10.1 and 25.9 days, respectively (p = 0.02). Grade 3 and 4 granulocytopenia complicated 27.7% of chemotherapy courses in control patients and only 4.8% in subjects receiving G-CSF (p <0.001). Similarly, severe infections and mucositis were significantly higher in patients receiving chemotherapy alone (15.6% and 3.6%, respectively) compared to the G-CSF group (4.8%, p = 0.01; p = 0.04, respectively). A mean of 1.1 days/course of hospitalization was required in the control group, as opposed to 0.2 days/course in patients receiving G-CSF (p = 0.05). Although overall treatmemt costs were higher in the control group, single cost of the recombinant growth factor exceeded by far all the other expenses in the G-CSF group, reaching a statistical relevance (p = 0.01). Conclusions: The inclusion of prophylactic G-CSF in the treatment plan for aggressive NHL in older patients appears safe and cost-effective in view of the peculiar clinical features of aged subjects and the possibility of delivering effective doses of antineoplastic drugs on an outpatient setting.

Original languageEnglish
Pages (from-to)127-132
Number of pages6
JournalAnnals of Oncology
Volume5
Issue numberSUPPL. 2
Publication statusPublished - 1994

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Granulocyte Colony-Stimulating Factor
Combination Drug Therapy
Non-Hodgkin's Lymphoma
Cost-Benefit Analysis
Drug Therapy
Costs and Cost Analysis
Control Groups
Intercellular Signaling Peptides and Proteins
Hospitalization
Therapeutics
Mucositis
Agranulocytosis
Granulocytes
Health Care Costs
Antineoplastic Agents
Outpatients

Keywords

  • hemopoietic growth factors
  • non-Hodgkin's lymphoma
  • older patients

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Zagonel, V., Babare, R., Merola, M. C., Talamini, R., Lazzarini, R., Tirelli, U., ... Monfardini, S. (1994). Cost-benefit of granulocyte colony-stimulating factor administration in older patients with non-Hodgkin's lymphoma treated with combination chemotherapy. Annals of Oncology, 5(SUPPL. 2), 127-132.

Cost-benefit of granulocyte colony-stimulating factor administration in older patients with non-Hodgkin's lymphoma treated with combination chemotherapy. / Zagonel, V.; Babare, R.; Merola, M. C.; Talamini, R.; Lazzarini, R.; Tirelli, U.; Carbone, A.; Monfardini, S.

In: Annals of Oncology, Vol. 5, No. SUPPL. 2, 1994, p. 127-132.

Research output: Contribution to journalArticle

Zagonel, V, Babare, R, Merola, MC, Talamini, R, Lazzarini, R, Tirelli, U, Carbone, A & Monfardini, S 1994, 'Cost-benefit of granulocyte colony-stimulating factor administration in older patients with non-Hodgkin's lymphoma treated with combination chemotherapy', Annals of Oncology, vol. 5, no. SUPPL. 2, pp. 127-132.
Zagonel, V. ; Babare, R. ; Merola, M. C. ; Talamini, R. ; Lazzarini, R. ; Tirelli, U. ; Carbone, A. ; Monfardini, S. / Cost-benefit of granulocyte colony-stimulating factor administration in older patients with non-Hodgkin's lymphoma treated with combination chemotherapy. In: Annals of Oncology. 1994 ; Vol. 5, No. SUPPL. 2. pp. 127-132.
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abstract = "Background: Older patients with non-Hodgkin's lymphoma (NHL) display a poorer response to chemotherapy and a significantly higher treatment-associated toxicity than do younger individuals. We investigated the potential clinical benefits and the cost-effectiveness of accelerated granulocyte recovery induced by recombinant granulocyte colony-stimulating factor (G-CSF) in patients with aggressive NHLs, aged 60-70 years, during treatment with a second-generation combination chemotherapy. Patients and methods: 12 consecutive patients (median age 66 years) treated with six to eight courses of CHVmP/ VB plus subcutaneous G-CSF (5 μg/kg/day) were compared with 11 consecutive subjects (median age 65 years) who received the same chemotherapy regimen without growth factor support. The two groups of patients were fully comparable as to the clinicopathologic features. A comparative analysis of treatment costs (including hospitalization, antimicrobial prophylaxis and therapy, supportive and diagnostic procedures, and G-CSF) was also performed. Results: Both the overall response rate and the percentage of complete remissions were comparable in the two treatment groups. In the control group, 32.5{\%} of chemotherapy courses were delayed, as opposed to 19{\%} in the G-CSF group (p = 0.05). The mean duration of delay for patients receiving or not receiving G-CSF was 10.1 and 25.9 days, respectively (p = 0.02). Grade 3 and 4 granulocytopenia complicated 27.7{\%} of chemotherapy courses in control patients and only 4.8{\%} in subjects receiving G-CSF (p <0.001). Similarly, severe infections and mucositis were significantly higher in patients receiving chemotherapy alone (15.6{\%} and 3.6{\%}, respectively) compared to the G-CSF group (4.8{\%}, p = 0.01; p = 0.04, respectively). A mean of 1.1 days/course of hospitalization was required in the control group, as opposed to 0.2 days/course in patients receiving G-CSF (p = 0.05). Although overall treatmemt costs were higher in the control group, single cost of the recombinant growth factor exceeded by far all the other expenses in the G-CSF group, reaching a statistical relevance (p = 0.01). Conclusions: The inclusion of prophylactic G-CSF in the treatment plan for aggressive NHL in older patients appears safe and cost-effective in view of the peculiar clinical features of aged subjects and the possibility of delivering effective doses of antineoplastic drugs on an outpatient setting.",
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T1 - Cost-benefit of granulocyte colony-stimulating factor administration in older patients with non-Hodgkin's lymphoma treated with combination chemotherapy

AU - Zagonel, V.

AU - Babare, R.

AU - Merola, M. C.

AU - Talamini, R.

AU - Lazzarini, R.

AU - Tirelli, U.

AU - Carbone, A.

AU - Monfardini, S.

PY - 1994

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N2 - Background: Older patients with non-Hodgkin's lymphoma (NHL) display a poorer response to chemotherapy and a significantly higher treatment-associated toxicity than do younger individuals. We investigated the potential clinical benefits and the cost-effectiveness of accelerated granulocyte recovery induced by recombinant granulocyte colony-stimulating factor (G-CSF) in patients with aggressive NHLs, aged 60-70 years, during treatment with a second-generation combination chemotherapy. Patients and methods: 12 consecutive patients (median age 66 years) treated with six to eight courses of CHVmP/ VB plus subcutaneous G-CSF (5 μg/kg/day) were compared with 11 consecutive subjects (median age 65 years) who received the same chemotherapy regimen without growth factor support. The two groups of patients were fully comparable as to the clinicopathologic features. A comparative analysis of treatment costs (including hospitalization, antimicrobial prophylaxis and therapy, supportive and diagnostic procedures, and G-CSF) was also performed. Results: Both the overall response rate and the percentage of complete remissions were comparable in the two treatment groups. In the control group, 32.5% of chemotherapy courses were delayed, as opposed to 19% in the G-CSF group (p = 0.05). The mean duration of delay for patients receiving or not receiving G-CSF was 10.1 and 25.9 days, respectively (p = 0.02). Grade 3 and 4 granulocytopenia complicated 27.7% of chemotherapy courses in control patients and only 4.8% in subjects receiving G-CSF (p <0.001). Similarly, severe infections and mucositis were significantly higher in patients receiving chemotherapy alone (15.6% and 3.6%, respectively) compared to the G-CSF group (4.8%, p = 0.01; p = 0.04, respectively). A mean of 1.1 days/course of hospitalization was required in the control group, as opposed to 0.2 days/course in patients receiving G-CSF (p = 0.05). Although overall treatmemt costs were higher in the control group, single cost of the recombinant growth factor exceeded by far all the other expenses in the G-CSF group, reaching a statistical relevance (p = 0.01). Conclusions: The inclusion of prophylactic G-CSF in the treatment plan for aggressive NHL in older patients appears safe and cost-effective in view of the peculiar clinical features of aged subjects and the possibility of delivering effective doses of antineoplastic drugs on an outpatient setting.

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