First, we examined the impact of excluding filgrastim cycles which has a shorter duration of filgrastim prophylaxis. 2nd, as the ex clusion of individuals find more info with proof of in excess of 1 pri mary cancer could inappropriately exclude patients with only one key cancer, that criterion was removed. Results Patient traits The first population from the claims database con tained 151,118 sufferers getting chemotherapy. Following applying the inclusion and exclusion criteria, the eli gible population included 3,535 individuals with breast cancer, lung cancer, NHL, ovarian cancer, or colorectal cancer receiving G CSF prophylaxis. These patients represented twelve,056 cycles all through which G CSF was delivered prophylactically, which includes 373 filgrastim cycles and eleven,683 pegfilgrastim cycles.
Base line demographics indicated that almost all individuals have been female using a indicate age of 55, with half in the pati ents from the Southern region of your United states of america. About half from the sufferers had breast cancer, using the following most regular cancers currently being lung cancer and NHL. Between all patient cycles within the sample, about 32% were connected that has a historical past of anemia within the 120 days just before the start off of every cycle. Filgrastim was employed to get a indicate of 4. eight injec tions per cycle compared to 1. 0 injections per cycle with pegfilgrastim, which was constant with pegfilgrastims as soon as per cycle indication. Threat of hospitalization Hospitalization data for a narrow definition of neutro penia, a broad definition of neutropenia, and all causes have been calculated and are described herein.
The incidence of neutropenia related hospitalization per cycle was 1. 3% with prophylactic filgrastim and 0. 6% with prophylactic pegfilgrastim . neutropenia associated hospitalization per cycle also occurred at a greater incidence with prophylactic filgras tim than with prophylactic pegfilgrastim . a greater incidence with prophylactic filgrastim than with prophylactic pegfilgrastim in all bring about hospitalizations per cycle was observed also. When in contrast with cycles during which filgrastim was prophylactically utilised, cycles by which prophylactic peg filgrastim was applied had been related by using a reduction from the threat of all result in hospitalizations and neutropenia associated hospitalization, just after controlling for patient, condition, and treatment method characteristics in GEE designs.
Sensitivity analyses were performed to examine the possible effects of length of filgrastim prophylaxis plus the presence of over 1 main cancer. Hospitalization chance for cycles during which filgrastim was used for 4 or extra days was examined. The OR for the comparison concerning filgrastim and pegfilgrastim did not alter appreciably from individuals observed during the key analysis. Comparable findings were observed when sufferers with more than 1 key cancer were included during the analyses.
The date on the first chemotherapy claim of an eligible patient was deemed the index date. Individuals have been integrated if they had two or more medical claims with ICD 9 code for NHL, breast cancer, lung cancer, ovarian cancer, or colorectal cancer from 30 days prior to the index date up selleck kinase inhibitor to thirty days after the index date, and one or a lot more declare for filgrastim or pegfilgrastim through the chemotherapy course. Claims from laboratories, diagnostic testing centers, or any diagnostic tests were not thought of when identifying cancer individuals, as well as claims with rule out codes. Individuals had been excluded if they had less than 1 year of continuous eligibility preceding the index date. any claim for chemotherapy throughout the 1 year just before the index date. one particular or a lot more health-related claims for bone marrow or stem cell transplant.
claims indicating sargramostim use. claims for companies supplied in experienced nursing facility or hospice solutions. or when they had codes for much more than 1 kind of primary cancer. Patients with metastatic condition were not exclusively excluded. Apart from tumor variety and utilization of pegfilgrastim/filgrastim, information collected also incorporated demographic characteristics, comorbid circumstances, cancer remedy historical past, and chemotherapy agents acquired in every chemotherapy cycle. The 1st eligible chemotherapy program for every patient right after January one, 2005 was made use of in this examination. Each and every chemotherapy course could contain numerous cycles. The very first chemotherapy course began to the index date and ended with any from the following, whichever came first 1 the absence of any chemotherapy claims inside the 60 days right after a chemotherapy claim .
two the end of insurance coverage eligibility or examine time period. or 3 the initiation of radiation treatment. Chemo treatment cycles inside the program have been defined to determine special cycles of interest, and have been excluded if two chemotherapy claims had much less than twenty days in between them or if there were chemotherapy claims from days 7 19 of a cycle. Chemotherapy cycle length was restricted to make sure a additional homogeneous remedy population constant using the labeled indications of the two filgrastim and pegfilgrastim, as pegfilgrastim is just not indicated to support weekly or each and every two week chemo treatment cycles. For both filgrastim and pegfilgrastim, use was categor ized as prophylactic or delayed. The analysis sample from the research only integrated cycles through which G CSF was used prophylactically. We utilized G CSF initiation in the course of days 1 five after the start off of your cycle to identify prophylaxis for two reasons most chemotherapy regimens are administered in excess of a one to three day time period, and G CSF prophylaxis is encouraged to get initiated inside 24 to 72 hours soon after chemotherapy .