The U.S. wastes more than $6 billion annually on popular white blood cell boosting drugs that have no medical benefits for most cancer patients using them, according to a clinical study published March 21 in the New England Journal of Medicine.
The drugs, filgastrim or pegylated filgastim (commonly known as Neupogen or G-CSF, and Neulasta or peg G-CSF), are routinely given to patients undergoing chemotherapy, but they only clinically benefit 10 percent of patients receiving them - elderly patients with multiple conditions. Ninety percent of patients who get the drugs, which can cost $3,000 per round, derive no clinical benefit.
The study, “Colony-Stimulating Factors for Febrile Neutropenia during Cancer Therapy: A Clinical Review,” summarizes a large body of evidence about the drugs and confirms recent recommendations by the American Society of Clinical Oncology and European experts that the drugs’ usage should be limited to a small subset of patients.
|Dr. Charlie Bennett|
“This is a great illustration of what’s wrong in the American health care system. We simply cannot afford as a country to continue wasting billions of dollars on treatments that do nothing to improve the health of patients,” said Charlie Bennett, M.D., Ph.D., endowed chair of the Center for Economic Excellence (CoEE) in Medication Safety and Efficacy and the Josie M. Fletcher Professor of Pharmacy at the University of South Carolina (USC) campus of the South Carolina College of Pharmacy.
Low white blood cell counts among cancer patients are typically treated with granulocyte colony-stimulating factor (G-CSF) or pegylated G-CSF (peg-G-CSF). Current guidelines indicate that these agents only should be used in settings where risks of low white blood cell counts causing infections are very high, such as advanced age or multiple illnesses. However, current practice amongst physicians is to administer these agents to almost all patients who receive chemotherapy in an effort to be “better safe than sorry.” The American Society of Clinical Oncology has developed an initiative called “Choosing Wisely” in collaboration with the American Board of Internal Medicine. This initiative identified overuse of G-CSF and peg-G-CSF as one of the five activities of oncologists that, if properly addressed, would both lower the health care costs of the country and also improve the well-being of cancer patients.
Bennett and colleagues summarized a large body of evidence using a clinical case study that found that many patients have a low risk (less than 20 percent) of developing fevers and low white blood cell counts in the first place. For these patients, if they do not have other risk factors such as older age or other medical illnesses, treatment with G-CSF or peg-G-CSF is not necessary, and is unlikely to improve their clinical course, prevent infections or lower the costs of medical care.
Bennett’s co-authors include LeAnn Norris, an assistant professor at the South Carolina College of Pharmacy, Benjamin Djulbegovic, a professor at the University of South Florida, and James Armitage, Joe Shapiro Professor of Internal Medicine, University of Nebraska Medical Center. Armitage is also a former president of the American Society of Clinical Oncology and an internationally renowned lymphoma clinician. Bennett and Armitage are co-authors of the national guidelines on G-CSF and GM-CSF.