Decision Analysis of Hematopoietic Growth Factor Use in Patients Receiving Cancer Chemotherapy
Background: Hematopoietic growth factors (HGFs) have been shown to reduce the incidence of neutropenia and fever in patients receiving cancer chemotherapy. Purpose: This cost analysis was designed to determine the conditions in which use of HGFs in patients receiving cancer chemotherapy is cost-effe...
Gespeichert in:
Veröffentlicht in: | JNCI : Journal of the National Cancer Institute 1993-03, Vol.85 (6), p.488-493 |
---|---|
Hauptverfasser: | , , , |
Format: | Artikel |
Sprache: | eng |
Schlagworte: | |
Online-Zugang: | Volltext |
Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
container_end_page | 493 |
---|---|
container_issue | 6 |
container_start_page | 488 |
container_title | JNCI : Journal of the National Cancer Institute |
container_volume | 85 |
creator | Lyman, Gary H. Lyman, Carolyn G. Sanderson, Roger A. Balducci, Lodovico |
description | Background: Hematopoietic growth factors (HGFs) have been shown to reduce the incidence of neutropenia and fever in patients receiving cancer chemotherapy. Purpose: This cost analysis was designed to determine the conditions in which use of HGFs in patients receiving cancer chemotherapy is cost-effective. Methods: We used a standard model based on decision theory; the model assumes that all patients experiencing neutropenia and fever will be hospitalized and treated with intravenous antibiotics. Data from a prospective, randomized clinical trial of granulocyte colony-stimulating factor in small-cell lung cancer treated with combination chemotherapy were used to determine baseline probabilities for control hospitalization risk and survival; proportional hospitalization risk with prophylactic HGF; and median durations of hospitalization and prophylactic HGF use. The model was analyzed by one-way and multivariate sensitivity analyses, with estimation of threshold values at which the expected cost is the same for either of two treatment options. One or more of the specific costs and durations and the probability for each group of threshold curves were varied in a sensitivity analysis that generated variable thresholds. Use of Monte Carlo analysis based on the available distributions of the main variables provided 90% confidence limits and an inference method for comparing decision options. Results: The expected excess cost per treatment cycle, based on hospitalization for neutropenic fever and/or HGF administration, was $5500 for no HGF, $4750 for prophylactic HGF, and $6875 for therapeutic HGF. Sensitivity analysis provided the following thresholds for no HGF versus prophylactic HGF: control risk of hospitalization, 0.40; risk of hospitalization with HGF as a proportion of control, 0.64; total daily cost of hospitalization, $727; total daily cost of HGF, $344; duration of hospitalization, 7.3 days; and duration of HGF use, 11.0 days. Multivariate analysis revealed that conditions favoring the use of HGF on a cost basis become greater (a) as risk of hospitalization, total daily hospital cost, and duration of hospitalization increase and (b) as the proportional risk of hospitalization with HGF, daily cost of HGF, and duration of HGF treatment decrease. Conclusions: The major determinants of total excess cost were the control risk of hospitalization the proportional reduction in risk with HGF, and the average daily hospital cost. Implications: Use of HGFs should |
doi_str_mv | 10.1093/jnci/85.6.488 |
format | Article |
fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_75617878</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>75617878</sourcerecordid><originalsourceid>FETCH-LOGICAL-c382t-d1a0944c8d4057bb3308555be33eb1b67c46bacc9b12e6b75b759f658c07038c3</originalsourceid><addsrcrecordid>eNpdkE1vEzEQhi1EVULhyBHJQojbpl5_77ENNKnaqoBaCXHA8jqzxGF3HWwHyL_HVaMgMRppDu-jGc2D0KuaTGvSsNP16PypFlM55Vo_QZOaS1LRmoinaEIIVZXWij9Dz1Nak1IN5cfoWHMupFIT9O09OJ98GPHZaPtd8gmHDi9gsDlsgofsHZ7H8Duv8IV1OUR8nwD7EX-02cOYE_4MDvwvP37HMzs6iHi2giHkFUS72b1AR53tE7zczxN0f_Hhbraorm_nl7Oz68oxTXO1rC1pOHd6yYlQbcsY0UKIFhiDtm6lcly21rmmrSnIVonSTSeFdkQRph07Qe8e925i-LmFlM3gk4O-tyOEbTJKyFpppQv45j9wHbaxvJ4MZUI0hGtSoOoRcjGkFKEzm-gHG3emJuZBunmQbrQw0hTphX-9X7ptB1ge6L3lkr_d5zY523exiPLpgHFFKWX031mfMvw5xDb-MFIxJcziy1dzNT-_uqHkznxifwFejJkX</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>235590480</pqid></control><display><type>article</type><title>Decision Analysis of Hematopoietic Growth Factor Use in Patients Receiving Cancer Chemotherapy</title><source>MEDLINE</source><source>Oxford Journals A-Z Collection</source><creator>Lyman, Gary H. ; Lyman, Carolyn G. ; Sanderson, Roger A. ; Balducci, Lodovico</creator><creatorcontrib>Lyman, Gary H. ; Lyman, Carolyn G. ; Sanderson, Roger A. ; Balducci, Lodovico</creatorcontrib><description>Background: Hematopoietic growth factors (HGFs) have been shown to reduce the incidence of neutropenia and fever in patients receiving cancer chemotherapy. Purpose: This cost analysis was designed to determine the conditions in which use of HGFs in patients receiving cancer chemotherapy is cost-effective. Methods: We used a standard model based on decision theory; the model assumes that all patients experiencing neutropenia and fever will be hospitalized and treated with intravenous antibiotics. Data from a prospective, randomized clinical trial of granulocyte colony-stimulating factor in small-cell lung cancer treated with combination chemotherapy were used to determine baseline probabilities for control hospitalization risk and survival; proportional hospitalization risk with prophylactic HGF; and median durations of hospitalization and prophylactic HGF use. The model was analyzed by one-way and multivariate sensitivity analyses, with estimation of threshold values at which the expected cost is the same for either of two treatment options. One or more of the specific costs and durations and the probability for each group of threshold curves were varied in a sensitivity analysis that generated variable thresholds. Use of Monte Carlo analysis based on the available distributions of the main variables provided 90% confidence limits and an inference method for comparing decision options. Results: The expected excess cost per treatment cycle, based on hospitalization for neutropenic fever and/or HGF administration, was $5500 for no HGF, $4750 for prophylactic HGF, and $6875 for therapeutic HGF. Sensitivity analysis provided the following thresholds for no HGF versus prophylactic HGF: control risk of hospitalization, 0.40; risk of hospitalization with HGF as a proportion of control, 0.64; total daily cost of hospitalization, $727; total daily cost of HGF, $344; duration of hospitalization, 7.3 days; and duration of HGF use, 11.0 days. Multivariate analysis revealed that conditions favoring the use of HGF on a cost basis become greater (a) as risk of hospitalization, total daily hospital cost, and duration of hospitalization increase and (b) as the proportional risk of hospitalization with HGF, daily cost of HGF, and duration of HGF treatment decrease. Conclusions: The major determinants of total excess cost were the control risk of hospitalization the proportional reduction in risk with HGF, and the average daily hospital cost. Implications: Use of HGFs should be based on the risk of hospitalization for neutropenic fever and consideration of the patient population and institutional costs. [J Natl Cancer Inst 85: 488–493, 1993]</description><identifier>ISSN: 0027-8874</identifier><identifier>EISSN: 1460-2105</identifier><identifier>DOI: 10.1093/jnci/85.6.488</identifier><identifier>PMID: 8445677</identifier><identifier>CODEN: JNCIEQ</identifier><language>eng</language><publisher>Cary, NC: Oxford University Press</publisher><subject>Antineoplastic agents ; Biological and medical sciences ; Chemotherapy ; Colony-Stimulating Factors - therapeutic use ; Cost-Benefit Analysis ; Decision Support Techniques ; Fever - prevention & control ; Health Care Costs ; Health care expenditures ; Hospitalization ; Humans ; Medical research ; Medical sciences ; Neoplasms - drug therapy ; Neutropenia - prevention & control ; Pharmacology. Drug treatments</subject><ispartof>JNCI : Journal of the National Cancer Institute, 1993-03, Vol.85 (6), p.488-493</ispartof><rights>1993 INIST-CNRS</rights><rights>Copyright Oxford University Press(England) Mar 17, 1993</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c382t-d1a0944c8d4057bb3308555be33eb1b67c46bacc9b12e6b75b759f658c07038c3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=4722232$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/8445677$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lyman, Gary H.</creatorcontrib><creatorcontrib>Lyman, Carolyn G.</creatorcontrib><creatorcontrib>Sanderson, Roger A.</creatorcontrib><creatorcontrib>Balducci, Lodovico</creatorcontrib><title>Decision Analysis of Hematopoietic Growth Factor Use in Patients Receiving Cancer Chemotherapy</title><title>JNCI : Journal of the National Cancer Institute</title><addtitle>J Natl Cancer Inst</addtitle><description>Background: Hematopoietic growth factors (HGFs) have been shown to reduce the incidence of neutropenia and fever in patients receiving cancer chemotherapy. Purpose: This cost analysis was designed to determine the conditions in which use of HGFs in patients receiving cancer chemotherapy is cost-effective. Methods: We used a standard model based on decision theory; the model assumes that all patients experiencing neutropenia and fever will be hospitalized and treated with intravenous antibiotics. Data from a prospective, randomized clinical trial of granulocyte colony-stimulating factor in small-cell lung cancer treated with combination chemotherapy were used to determine baseline probabilities for control hospitalization risk and survival; proportional hospitalization risk with prophylactic HGF; and median durations of hospitalization and prophylactic HGF use. The model was analyzed by one-way and multivariate sensitivity analyses, with estimation of threshold values at which the expected cost is the same for either of two treatment options. One or more of the specific costs and durations and the probability for each group of threshold curves were varied in a sensitivity analysis that generated variable thresholds. Use of Monte Carlo analysis based on the available distributions of the main variables provided 90% confidence limits and an inference method for comparing decision options. Results: The expected excess cost per treatment cycle, based on hospitalization for neutropenic fever and/or HGF administration, was $5500 for no HGF, $4750 for prophylactic HGF, and $6875 for therapeutic HGF. Sensitivity analysis provided the following thresholds for no HGF versus prophylactic HGF: control risk of hospitalization, 0.40; risk of hospitalization with HGF as a proportion of control, 0.64; total daily cost of hospitalization, $727; total daily cost of HGF, $344; duration of hospitalization, 7.3 days; and duration of HGF use, 11.0 days. Multivariate analysis revealed that conditions favoring the use of HGF on a cost basis become greater (a) as risk of hospitalization, total daily hospital cost, and duration of hospitalization increase and (b) as the proportional risk of hospitalization with HGF, daily cost of HGF, and duration of HGF treatment decrease. Conclusions: The major determinants of total excess cost were the control risk of hospitalization the proportional reduction in risk with HGF, and the average daily hospital cost. Implications: Use of HGFs should be based on the risk of hospitalization for neutropenic fever and consideration of the patient population and institutional costs. [J Natl Cancer Inst 85: 488–493, 1993]</description><subject>Antineoplastic agents</subject><subject>Biological and medical sciences</subject><subject>Chemotherapy</subject><subject>Colony-Stimulating Factors - therapeutic use</subject><subject>Cost-Benefit Analysis</subject><subject>Decision Support Techniques</subject><subject>Fever - prevention & control</subject><subject>Health Care Costs</subject><subject>Health care expenditures</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Medical research</subject><subject>Medical sciences</subject><subject>Neoplasms - drug therapy</subject><subject>Neutropenia - prevention & control</subject><subject>Pharmacology. Drug treatments</subject><issn>0027-8874</issn><issn>1460-2105</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1993</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkE1vEzEQhi1EVULhyBHJQojbpl5_77ENNKnaqoBaCXHA8jqzxGF3HWwHyL_HVaMgMRppDu-jGc2D0KuaTGvSsNP16PypFlM55Vo_QZOaS1LRmoinaEIIVZXWij9Dz1Nak1IN5cfoWHMupFIT9O09OJ98GPHZaPtd8gmHDi9gsDlsgofsHZ7H8Duv8IV1OUR8nwD7EX-02cOYE_4MDvwvP37HMzs6iHi2giHkFUS72b1AR53tE7zczxN0f_Hhbraorm_nl7Oz68oxTXO1rC1pOHd6yYlQbcsY0UKIFhiDtm6lcly21rmmrSnIVonSTSeFdkQRph07Qe8e925i-LmFlM3gk4O-tyOEbTJKyFpppQv45j9wHbaxvJ4MZUI0hGtSoOoRcjGkFKEzm-gHG3emJuZBunmQbrQw0hTphX-9X7ptB1ge6L3lkr_d5zY523exiPLpgHFFKWX031mfMvw5xDb-MFIxJcziy1dzNT-_uqHkznxifwFejJkX</recordid><startdate>19930317</startdate><enddate>19930317</enddate><creator>Lyman, Gary H.</creator><creator>Lyman, Carolyn G.</creator><creator>Sanderson, Roger A.</creator><creator>Balducci, Lodovico</creator><general>Oxford University Press</general><general>Superintendent of Documents</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>19930317</creationdate><title>Decision Analysis of Hematopoietic Growth Factor Use in Patients Receiving Cancer Chemotherapy</title><author>Lyman, Gary H. ; Lyman, Carolyn G. ; Sanderson, Roger A. ; Balducci, Lodovico</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c382t-d1a0944c8d4057bb3308555be33eb1b67c46bacc9b12e6b75b759f658c07038c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1993</creationdate><topic>Antineoplastic agents</topic><topic>Biological and medical sciences</topic><topic>Chemotherapy</topic><topic>Colony-Stimulating Factors - therapeutic use</topic><topic>Cost-Benefit Analysis</topic><topic>Decision Support Techniques</topic><topic>Fever - prevention & control</topic><topic>Health Care Costs</topic><topic>Health care expenditures</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Medical research</topic><topic>Medical sciences</topic><topic>Neoplasms - drug therapy</topic><topic>Neutropenia - prevention & control</topic><topic>Pharmacology. Drug treatments</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lyman, Gary H.</creatorcontrib><creatorcontrib>Lyman, Carolyn G.</creatorcontrib><creatorcontrib>Sanderson, Roger A.</creatorcontrib><creatorcontrib>Balducci, Lodovico</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>JNCI : Journal of the National Cancer Institute</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lyman, Gary H.</au><au>Lyman, Carolyn G.</au><au>Sanderson, Roger A.</au><au>Balducci, Lodovico</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Decision Analysis of Hematopoietic Growth Factor Use in Patients Receiving Cancer Chemotherapy</atitle><jtitle>JNCI : Journal of the National Cancer Institute</jtitle><addtitle>J Natl Cancer Inst</addtitle><date>1993-03-17</date><risdate>1993</risdate><volume>85</volume><issue>6</issue><spage>488</spage><epage>493</epage><pages>488-493</pages><issn>0027-8874</issn><eissn>1460-2105</eissn><coden>JNCIEQ</coden><abstract>Background: Hematopoietic growth factors (HGFs) have been shown to reduce the incidence of neutropenia and fever in patients receiving cancer chemotherapy. Purpose: This cost analysis was designed to determine the conditions in which use of HGFs in patients receiving cancer chemotherapy is cost-effective. Methods: We used a standard model based on decision theory; the model assumes that all patients experiencing neutropenia and fever will be hospitalized and treated with intravenous antibiotics. Data from a prospective, randomized clinical trial of granulocyte colony-stimulating factor in small-cell lung cancer treated with combination chemotherapy were used to determine baseline probabilities for control hospitalization risk and survival; proportional hospitalization risk with prophylactic HGF; and median durations of hospitalization and prophylactic HGF use. The model was analyzed by one-way and multivariate sensitivity analyses, with estimation of threshold values at which the expected cost is the same for either of two treatment options. One or more of the specific costs and durations and the probability for each group of threshold curves were varied in a sensitivity analysis that generated variable thresholds. Use of Monte Carlo analysis based on the available distributions of the main variables provided 90% confidence limits and an inference method for comparing decision options. Results: The expected excess cost per treatment cycle, based on hospitalization for neutropenic fever and/or HGF administration, was $5500 for no HGF, $4750 for prophylactic HGF, and $6875 for therapeutic HGF. Sensitivity analysis provided the following thresholds for no HGF versus prophylactic HGF: control risk of hospitalization, 0.40; risk of hospitalization with HGF as a proportion of control, 0.64; total daily cost of hospitalization, $727; total daily cost of HGF, $344; duration of hospitalization, 7.3 days; and duration of HGF use, 11.0 days. Multivariate analysis revealed that conditions favoring the use of HGF on a cost basis become greater (a) as risk of hospitalization, total daily hospital cost, and duration of hospitalization increase and (b) as the proportional risk of hospitalization with HGF, daily cost of HGF, and duration of HGF treatment decrease. Conclusions: The major determinants of total excess cost were the control risk of hospitalization the proportional reduction in risk with HGF, and the average daily hospital cost. Implications: Use of HGFs should be based on the risk of hospitalization for neutropenic fever and consideration of the patient population and institutional costs. [J Natl Cancer Inst 85: 488–493, 1993]</abstract><cop>Cary, NC</cop><pub>Oxford University Press</pub><pmid>8445677</pmid><doi>10.1093/jnci/85.6.488</doi><tpages>6</tpages></addata></record> |
fulltext | fulltext |
identifier | ISSN: 0027-8874 |
ispartof | JNCI : Journal of the National Cancer Institute, 1993-03, Vol.85 (6), p.488-493 |
issn | 0027-8874 1460-2105 |
language | eng |
recordid | cdi_proquest_miscellaneous_75617878 |
source | MEDLINE; Oxford Journals A-Z Collection |
subjects | Antineoplastic agents Biological and medical sciences Chemotherapy Colony-Stimulating Factors - therapeutic use Cost-Benefit Analysis Decision Support Techniques Fever - prevention & control Health Care Costs Health care expenditures Hospitalization Humans Medical research Medical sciences Neoplasms - drug therapy Neutropenia - prevention & control Pharmacology. Drug treatments |
title | Decision Analysis of Hematopoietic Growth Factor Use in Patients Receiving Cancer Chemotherapy |
url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-25T10%3A22%3A50IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Decision%20Analysis%20of%20Hematopoietic%20Growth%20Factor%20Use%20in%20Patients%20Receiving%20Cancer%20Chemotherapy&rft.jtitle=JNCI%20:%20Journal%20of%20the%20National%20Cancer%20Institute&rft.au=Lyman,%20Gary%20H.&rft.date=1993-03-17&rft.volume=85&rft.issue=6&rft.spage=488&rft.epage=493&rft.pages=488-493&rft.issn=0027-8874&rft.eissn=1460-2105&rft.coden=JNCIEQ&rft_id=info:doi/10.1093/jnci/85.6.488&rft_dat=%3Cproquest_cross%3E75617878%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=235590480&rft_id=info:pmid/8445677&rfr_iscdi=true |