Weighing Prevention Versus Cost

Growth factors, such as Neupogen or Neulasta, can be expensive. One course to prevent neutropenia costs $1,900 to $2,800, and patients typically receive it with each chemotherapy cycle.

“Concern about cost is a little short-sighted because hospitalization with febrile neutropenia is also associated with considerable cost,” says Gary Lyman, MD. A recent study in Cancer found that the average hospital bill was almost $20,000 per episode. “The growth factors, while expensive, can actually be cost-saving. When the risk of neutropenia is 20 percent or higher, you actually save money by avoiding hospitalization.”

The American Society of Clinical Oncology updated its guidelines earlier this year to call for growth factors if a patient has at least a 20 percent chance of febrile neutropenia as a result of chemotherapy, a recommendation already made by the National Comprehensive Cancer Network, an alliance of the country’s top 20 cancer centers. (The previous ASCO guideline was 40 percent or higher.) The cost efficacy is determined by the cost per day of hospitalization. The initial model, and the one ASCO and most insurance companies go by is $1,000 per day. An updated analysis averaged the cost at over $1,700 per day, lowering the risk threshold to about 20 percent.

But the cost of the drug is not the only issue patients and health officials are concerned with when determining when to use growth factors. Delay or reduction of chemotherapy during times the patient has an infection is also a factor.

Relatively healthy patients who are not at high risk for infection may not need growth factors unless they are on higher doses of chemotherapy, but patients who are elderly, have compromised immune systems or receive dose-dense chemotherapy or stem cell transplants are in greater need of growth factors.

Medicare and private insurance companies typically pay a portion of the cost. If the drug is administered at a hospital or doctor’s office, Medicare will cover it as an injectable drug. Patients with Medicare prescription drug coverage will be able to give themselves the injections at home, but convenience is often accompanied with a high co-payment. Amgen’s program, SafetyNet, provides Neupogen or Neulasta to uninsured or underinsured patients through a doctor referral. For information on SafetyNet, call 800-272-9376.