Economic evaluation of prophylactic granulocyte colony-stimulating factor during chemotherapy in elderly patients with aggressive non-Hodgkin's lymphoma

Background and Objectives. Treatment with CHOP chemotherapy in elderly patients with aggressive non-Hodgkin's lymphoma (NHL) is less effective and accompanied by more adverse effects than in younger patients. The prophylactic use of granulocyte colony-stimulating factor (G-CSF) might improve the results, but increases the costs of treatment. We analyzed the costs of therapy and follow-up of patients with NHL treated with CHOP with or without G-CSF prophylaxis. Design and Methods. Four hundred and eleven patients were randomized for treatment with CHOP or CHOP+G-CSF. A detailed study of treatment costs from randomization until 3 years of follow-up or death was performed in a subset of 100 out of 389 eligible patients. Because costs during follow-up were independent of the use of G-CSF during treatment, costs of follow-up and second-line treatment were calculated irrespective of the treatment arm. Results. Total hospital costs for first-line treatment were €12178 [95% CI €10297 - €14059] or CHOP alone and €18356 [95% CI €15807 - €20906] for CHOP + G-CSF. Costs during follow-up showed a wide difference (range €74 - €53925) depending on disease status and choice of treatment in the case of relapse or progression. Interpretation and Conclusions. The clinical study showed no difference between the treatment arms in response, overall survival or event-free survival, while the costs were significantly higher in the G-CSF arm. We conclude that the addition of prophylactic G-CSF to CHOP chemotherapy is not cost-effective in these patients.