Uptake and economic impact of first-cycle colony-stimulating factor use during adjuvant treatment of breast cancer.

Abstract

PURPOSE:

In 2002, pegfilgrastim was approved by the US Food and Drug Administration and the benefits of dose-dense breast cancer chemotherapy, especially for hormone receptor (HR) -negative tumors, were reported. We examined first-cycle colony-stimulating factor use (FC-CSF) before and after 2002 and estimated US expenditures for dose-dense chemotherapy.

METHODS:

We identified patients in Surveillance, Epidemiology, and End Results-Medicare greater than 65 years old with stages I to III breast cancer who had greater than one chemotherapy claim within 6 months of diagnosis(1998 to 2005) and classified patients with an average cycle length less than 21 days as having received dose-dense chemotherapy. The associations of patient, tumor, and physician-related factors with the receipt of any colony-stimulating factor (CSF) and FC-CSF use were analyzed by using generalized estimating equations. CSF costs were estimated for patients who were undergoing dose-dense chemotherapy.

RESULTS:

Among the 10,773 patients identified, 5,266 patients (48.9%) had a CSF claim. CSF use was stable between 1998 and 2002 and increased from 36.8% to 73.7% between 2002 and 2005, FC-CSF use increased from 13.2% to 67.9%, and pegfilgrastim use increased from 4.1% to 83.6%. In a multivariable analysis, CSF use was associated with age and chemotherapy type and negatively associated with black/Hispanic race, rural residence, and shorter chemotherapy duration. FC-CSF use was associated with high socioeconomic status but not with age or race/ethnicity. The US annual CSF expenditure for women with HR-positive tumors treated with dose-dense chemotherapy is estimated to be $38.8 million.

CONCLUSION:

A rapid increase in FC-CSF use occurred over a short period of time, which was likely a result of the reported benefits of dose-dense chemotherapy and the ease of pegfilgrastim administration. Because of the increasing evidence that elderly HR-positive patients do not benefit from dose-dense chemotherapy, limiting pegfilgrastim use would combat the increasing costs of cancer care.

• Authors: Dawn L Hershman, Elizabeth T Wilde, Jason D Wright, Donna L Buono, Kevin Kalinsky, Jennifer L Malin, Alfred I Neugut
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 30 Issue 8 Pg. 806-12 (Mar 10 2012) ISSN: 1527-7755 [Electronic] United States
• PMID: 22312106 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Chemical References

• Colony-Stimulating Factors
• Recombinant Proteins
• Granulocyte Colony-Stimulating Factor
• pegfilgrastim
• Polyethylene Glycols
• Filgrastim

Topics

• Aged
• Aged, 80 and over
• Breast Neoplasms (drug therapy, economics)
• Chemotherapy, Adjuvant
• Colony-Stimulating Factors (administration & dosage, economics)
• Female
• Filgrastim
• Granulocyte Colony-Stimulating Factor (therapeutic use)
• Humans
• Neoplasms, Hormone-Dependent (drug therapy)
• Polyethylene Glycols
• Recombinant Proteins (therapeutic use)
• SEER Program
• Socioeconomic Factors
• United States