Background: Myelosuppressive chemotherapy can lead to dose-limiting febrile neutropenia. Prophylactic use of\r\nrecombinant human G-CSF such as daily filgrastim and once-per-cycle pegfilgrastim may reduce the incidence\r\nof febrile neutropenia. This comparative study examined the effect of pegfilgrastim versus daily filgrastim on the\r\nrisk of hospitalization.\r\nMethods: This retrospective United States claims analysis utilized 2004ââ?¬â??2009 data for filgrastim- and\r\npegfilgrastim-treated patients receiving chemotherapy for non-Hodgkinââ?¬â?¢s lymphoma (NHL) or breast, lung,\r\novarian, or colorectal cancers. Cycles in which pegfilgrastim or filgrastim was administered within 5 days from\r\ninitiation of chemotherapy (considered to represent prophylaxis) were pooled for analysis. Neutropenia-related\r\nhospitalization and other healthcare encounters were defined with a ââ?¬Å?narrowââ?¬Â criterion for claims with an ICD-9\r\ncode for neutropenia and with a ââ?¬Å?broadââ?¬Â criterion for claims with an ICD-9 code for neutropenia, fever, or\r\ninfection. Odds ratios (OR) for hospitalization and 95% confidence intervals (CI) were estimated by generalized\r\nestimating equation (GEE) models and adjusted for patient, tumor, and treatment characteristics. Per-cycle\r\nhealthcare utilization and costs were examined for cycles with pegfilgrastim or filgrastim prophylaxis.\r\nResults: We identified 3,535 patients receiving G-CSF prophylaxis, representing 12,056 chemotherapy cycles\r\n(11,683 pegfilgrastim, 373 filgrastim). The mean duration of filgrastim prophylaxis in the sample was 4.8 days.\r\nThe mean duration of pegfilgrastim prophylaxis in the sample was 1.0 day, consistent with the recommended\r\ndosage of pegfilgrastim - a single injection once per chemotherapy cycle. Cycles with prophylactic pegfilgrastim\r\nwere associated with a decreased risk of neutropenia-related hospitalization (narrow definition: OR = 0.43, 95%\r\nCI: 0.16ââ?¬â??1.13; broad definition: OR = 0.38, 95% CI: 0.24ââ?¬â??0.59) and all-cause hospitalization (OR = 0.50, 95% CI:\r\n0.35ââ?¬â??0.72) versus cycles with prophylactic filgrastim. For neutropenia-related utilization by setting of care, there\r\nwere more ambulatory visits and hospitalizations per cycle associated with filgrastim prophylaxis than with\r\npegfilgrastim prophylaxis. Mean per-cycle neutropenia-related costs were also higher with prophylactic filgrastim\r\nthan with prophylactic pegfilgrastim.\r\nConclusions: In this comparative effectiveness study, pegfilgrastim prophylaxis was associated with a reduced\r\nrisk of neutropenia-related or all-cause hospitalization relative to filgrastim prophylaxis.
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