Abstract

Abstract 1515

Objective:

Patients receiving myelosuppressive chemotherapy are at risk for developing febrile neutropenia, a major dose-limiting toxicity of systemic chemotherapy. Prophylactic use of recombinant human granulocyte colony-stimulating factors (G-CSF), such as filgrastim used daily for up to two weeks and pegfilgrastim used once per cycle, decreases the incidence of febrile neutropenia. Cancer delivery models are under pressure to become more efficient in an increasingly cost-restrictive environment. The use of growth factors to help prevent febrile neutropenia is well established, but little is known regarding the use of practice resources necessary to deliver therapy. The objective of this study was to construct an empirical model to calculate the human resource time and cost associated with delivery of filgrastim and pegfilgrastim.

Methods:

A practice-level model was constructed detailing staff tasks required for the administration of G-CSF on a monthly basis. Key model inputs include specific clinic characteristics, such as the number of patients treated with G-CSF, the number of filgrastim injections administered per cycle, and hourly pay rates for nurses and clerks. As described by Fortner et al (Community Oncology 2004, 1:23-28), interviews were conducted with 400 medical professionals at 20 US community oncology practices to provide data for the time required for the tasks involved in G-CSF delivery (scheduling, front desk, phlebotomy, laboratory, triage, injection, and billing). Model outputs were time expended for each staff type for administration of filgrastim or pegfilgrastim and corresponding labor costs. Costs for drug (filgrastim or pegfilgrastim), laboratory tests, and other materials were excluded from this model. The base-case scenarios contrasted 1 patient vs. 30 patients per month. Also examined were results for patients who received 11 injections of filgrastim per chemotherapy cycle, reflecting the mean number of injections received per cycle in the pegfilgrastim registrational clinical trials, and patients receiving 6 injections per cycle, as observed in current clinical practice. Using Bureau of Labor Statistics data, hourly pay rates were assumed to be $31.28 for nurses and $12.35 for clerks.

Results:

Table 1 displays monthly opportunity costs in hours and dollars of using once-per-cycle pegfilgrastim injection as compared with filgrastim given as either 6 or 11 injections per cycle. Alternate cost and time assumptions, with 95% confidence intervals for salary and time inputs, are shown in parentheses.

Conclusions:

The 30-patient model predicts monthly opportunity costs with pegfilgrastim as compared with filgrastim of 378 to 756 staff hours and between $9,000 and $18,000. On a per-patient basis, the monthly opportunity cost would be 13 to 25 staff hours and $300 to $600. Use of pegfilgrastim as compared with filgrastim is associated with substantial savings in time and labor costs. Future medical care delivery models should consider practice resource requirements as a means of increasing efficiency and cost effectiveness.

Table 1

Monthly time and cost savings of using pegfilgrastim as compared with filgrastim

# of patients treated with G-CSF per month130
Prophylaxis strategyFilgrastimOnce-per-cycle Pegfilgrastim injectionFilgrastimOnce-per-cycle Pegfilgrastim injection
# of filgrastim injections per cycle 11 11 
Nurse hours 9.4 (6.4,12) 17.3 (12,23) 1.5 (1.0,2.0) 283 (192,374) 519 (351,686) 46 (31,61) 
Clerk hours 5.7 (3.9,7) 10.4 (7,14) 0.9 (0.7,1.2) 170 (118,222) 311 (216,407) 28 (19.6,37) 
Total hours 15.1 (10.3,20) 27.7 (19,36) 2.5 (1.7,3.3) 453 (309,596) 830 (567,1093) 75 (50.6,98) 
Opportunity cost with pegfilgrastim (in hours) 12.6 (8.6,17) 25.2 (17,33)  378 (259,498) 756 (516,995)  
Costs ($) 365 (244,489) 668 (448,896) 60 (40,80) 10,945 (7,329,14,664) 20,066 (13,437,26,886) 1,795 (1,192,2,414) 
Opportunity cost with pegfilgrastim ($) 305 (205,408) 609 (408,816)  9,151 (6.137,12,250) 18,271 (12,244,24,472)  
# of patients treated with G-CSF per month130
Prophylaxis strategyFilgrastimOnce-per-cycle Pegfilgrastim injectionFilgrastimOnce-per-cycle Pegfilgrastim injection
# of filgrastim injections per cycle 11 11 
Nurse hours 9.4 (6.4,12) 17.3 (12,23) 1.5 (1.0,2.0) 283 (192,374) 519 (351,686) 46 (31,61) 
Clerk hours 5.7 (3.9,7) 10.4 (7,14) 0.9 (0.7,1.2) 170 (118,222) 311 (216,407) 28 (19.6,37) 
Total hours 15.1 (10.3,20) 27.7 (19,36) 2.5 (1.7,3.3) 453 (309,596) 830 (567,1093) 75 (50.6,98) 
Opportunity cost with pegfilgrastim (in hours) 12.6 (8.6,17) 25.2 (17,33)  378 (259,498) 756 (516,995)  
Costs ($) 365 (244,489) 668 (448,896) 60 (40,80) 10,945 (7,329,14,664) 20,066 (13,437,26,886) 1,795 (1,192,2,414) 
Opportunity cost with pegfilgrastim ($) 305 (205,408) 609 (408,816)  9,151 (6.137,12,250) 18,271 (12,244,24,472)  
Disclosures:

Taylor:i3 Innovus: Employment; Amgen Inc.: Consultancy, Research Funding. Skornecki:i3 Innovus: Employment; Amgen Inc.: Consultancy, Research Funding. Hill:i3 Innovus: Employment; Amgen Inc.: Consultancy, Research Funding. Barron:Amgen Inc.: Employment, Equity Ownership, Research Funding. Anstead:Amgen Inc.: Employment, Equity Ownership. Fortner:P4 Healthcare: Employment. Ozer-Deniz:i3 Innovus: Employment; Amgen Inc.: Consultancy, Research Funding.

Author notes

*

Asterisk with author names denotes non-ASH members.