Granulocyte colony-stimulating factors for primary prophylaxis of febrile neutropenia: Cost-effectiveness analysis and impact on survival outcomes

Introduction . The development of febrile neutropenia (FN) is associated with high mortality and significant healthcare costs. Currently, granulocyte colony-stimulating factors (G-CSF) are recommended for patients with at least one clinical risk factor for FN in chemotherapy (CT) regimens with an intermediate risk of complications (10–20%). The question remains open as to how optimally FN prevention is carried out and how the use of G-CSF affects the budget of a medical institution in the treatment of patients with an intermediate risk of complications. Aim . To assess the impact of primary FN prevention on the costs of a medical institution and on survival rates in patients undergoing intermediate-risk CT regimens. Materials and methods . A retrospective analysis of 252 patient medical records was conducted (average age 66.8 years; 52% women, 48% men). A model was developed to assess the impact on the budget of a medical institution, taking into account direct medical costs for prevention, laboratory and instrumental studies, and treatment of episodes of neutropenic complications, as well as patient death by the time of analysis. Results . Direct costs per patient for FN prevention amounted to 53,095.26 RUB and were 6% higher (3,212.16 RUB) compared to the group without prevention. Primary FN prevention led to a reduction in episodes of neutropenia, with a risk difference in the FN prevention group -26.1 (95% CI -35.6; -14.1), p < 0.001. As a result, one-year survival in the neutropenia prevention group was statistically significantly lower at 66.1% (41 out of 62), and costs per patient were 33% lower (19,840.44 RUB) compared to the group without prevention. Conclusion . The prescription of primary prevention using G-CSF is associated with a reduction in the frequency of neutropenia development and an improvement in both immediate and long-term outcomes, positively affecting the institution’s budget.