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Are Colony-Stimulating Factors Cost-Effective?

Colony-stimulating factors promote the proliferation of certain bone marrow cell populations, and their use following chemotherapy is thought to reduce the risk of infection. This treatment is widespread following chemotherapy, despite the absence of conclusive supportive data and the high cost of these drugs. Rubino et al. (p. 750) performed a cost analysis of this treatment as part of a clinical trial that used granulocyte colonystimulating factor ( G-CSF) following chemotherapy in children with nonHodgkin's lymphoma. These investigators reported that the cost of chemotherapy in the G-CSF-treated group was slightly lower than that for the same treatment strategy without G-CSF, but not by a statistically significant amount. A slight reduction in the length of hospitalization was reported for these children, although no clinical benefit was observed. Given the lack of a strong economic benefit and an equivocal clinical benefit, the authors conclude that systemic G-CSF treatment following chemotherapy in this pediatric population is oflittle use.