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Granulocyte colony-stimulating factor in established febrile neutropenia: a randomized study of pediatric patients
P L Mitchell1, B Morland, M C Stevens
1Department of Paediatric Oncology, Royal Marsden National Health Service Trust, Sutton, Surrey, United Kingdom.
Insights
Granulocyte colony-stimulating factor (G-CSF) treatment in children with febrile neutropenia significantly reduced hospital stays and antibiotic use. This intervention shows potential cost savings for pediatric healthcare resource utilization.
Area of Science:
- Pediatric Hematology
- Infectious Diseases
- Health Economics
Background:
- Febrile neutropenia in children poses life-threatening risks and significant healthcare costs.
- Prophylactic cytokine use may benefit a small patient subset, raising questions of cost-effectiveness.
Purpose of the Study:
- To evaluate the impact of granulocyte colony-stimulating factor (G-CSF) on outcomes in pediatric patients with established febrile neutropenia.
- To assess the potential cost-effectiveness of G-CSF treatment in this patient population.
Main Methods:
- A double-blind, randomized study involving pediatric patients with fever and severe neutropenia.
- Patients received either G-CSF (filgrastim) or placebo alongside antibiotics.
- Discharge criteria included fever resolution and neutrophil count ≥ 0.2 x 10(9)/L.
Main Results:
- G-CSF treatment resulted in shorter hospital stays (median 5 vs. 7 days) and reduced antibiotic use (median 5 vs. 6 days).
- Patients receiving G-CSF experienced faster neutrophil recovery and higher levels at discharge.
- A 2-day reduction in hospital stay led to a 29% decrease in median bed costs per admission.
Conclusions:
- G-CSF use in established febrile neutropenia significantly shortened antibiotic duration and hospital admission time in children.
- The findings suggest potential cost savings under institutional clinical guidelines.
- G-CSF offers a valuable therapeutic option for managing febrile neutropenia in pediatric patients.
Purpose:
Infection in neutropenic patients is potentially life-threatening and carries important implications for hospital resource use. Prophylactic administration of cytokines may reduce the severity of neutropenia, but involves the treatment of all patients for the possible benefit of a minority. This study evaluates whether treatment with cytokines in the setting of established febrile neutropenia will influence outcome and be potentially more cost-effective.
Patients And Methods:
In a double-blind study, pediatric patients with fever and severe neutropenia were randomized to receive granulocyte colony-stimulating factor ([G-CSF] filgrastim; 5 microg/kg/d) or placebo, in addition to antibiotics. The study protocol required a resolution of fever and a neutrophil count > or = 0.2 x 10(9)/L for hospital discharge. Patients could be randomized for up to four independent febrile episodes. A total of 186 episodes of febrile neutropenia were investigated.
Results:
Patients randomized to G-CSF had a shorter hospital stay (median, 5 v 7 days; P = .04) and fewer days of antibiotic use (median, 5 v 6 days; P = .02). G-CSF-treated patients also had more rapid neutrophil recovery and higher neutrophil levels at discharge. The 2-day reduction in hospital stay reduced the median bed cost by 29% per patient admission (P = .04).
Conclusion:
Under the clinical guidelines of our institution, the use of G-CSF in the treatment of established febrile neutropenia produced a small but significant reduction in the time that children required antibiotics and hospital admission, with possible cost savings.