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Open Access Research article

Risk and consequences of chemotherapy-induced neutropenic complications in patients receiving daily filgrastim: the importance of duration of prophylaxis

Derek Weycker1*, Rich Barron2, John Edelsberg1, Alex Kartashov1, Jason Legg2 and Andrew G Glass3

Author Affiliations

1 Policy Analysis Inc. (PAI), Four Davis Court, Brookline, MA, USA

2 Amgen Incorporation, Thousand Oaks, CA, USA

3 Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA

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BMC Health Services Research 2014, 14:189  doi:10.1186/1472-6963-14-189

Published: 27 April 2014

Abstract

Background

To examine duration of daily filgrastim prophylaxis, and risk and consequences of chemotherapy-induced neutropenic complications (CINC) requiring inpatient care.

Methods

Using a retrospective cohort design and US healthcare claims data (2001–2010), we identified all cancer patients who initiated ≥1 course of myelosuppressive chemotherapy and received daily filgrastim prophylactically in ≥1 cycle. Cycles with daily filgrastim prophylaxis were pooled for analyses. CINC was identified based on hospital admissions with a diagnosis of neutropenia, fever, or infection; consequences were characterized in terms of hospital mortality, hospital length of stay (LOS), and CINC-related healthcare expenditures.

Results

Risk of CINC requiring inpatient care–adjusted for patient characteristics–was 2.4 (95% CI: 1.6-3.4) and 1.9 (1.3-2.8) times higher with 1–3 (N = 8371) and 4–6 (N = 3691) days of filgrastim prophylaxis, respectively, versus ≥7 days (N = 2226). Among subjects who developed CINC, consequences with 1–3 and 4–6 (vs. ≥7) days of filgrastim prophylaxis were: mortality (8.4% [n/N = 10/119] and 4.0% [3/75] vs. 0% [0/34]); LOS (means: 7.4 [N = 243] and 7.1 [N = 99] vs. 6.5 [N = 40]); and expenditures (means: $18,912 [N = 225] and $14,907 [N = 94] vs. $13,165 [N = 39]).

Conclusions

In this retrospective evaluation, shorter courses of daily filgrastim prophylaxis were found to be associated with an increased risk of CINC as well as poorer outcomes among those developing this condition. Because of the limitations inherent in healthcare claims databases specifically and retrospective evaluations generally, additional research addressing these limitations is needed to confirm the findings of this study.

Keywords:
Filgrastim; Granulocyte colony-stimulating factor; Febrile neutropenia; Cost; Neoplasms