Febrile neutropenia prophylaxis, G-CSF physician preferences: discrete-choice experiment

Abstract

Objectives: Febrile neutropenia (FN) commonly occurs during cancer chemotherapy. Prophylaxis with granulocyte colony-stimulating factors (G-CSFs) is known to reduce the severity and incidence of FN and infections in patients with cancer. Despite the proven efficacy, G-CSFs are not always prescribed as recommended. We performed a discrete-choice experiment (DCE) to determine what factors drive the physician preference for FN prophylaxis in patients with cancer undergoing chemotherapy.

Methods: Attributes for the DCE were selected based on literature search and on expert focus group discussions and comprised pain at the injection site, presence of bone pain, associated fever/influenza syndrome, efficacy of prophylaxis, biosimilar availability, number of injections per chemotherapy cycle and cost. Oncologists, in a national database, were solicited to participate in an online DCE. The study collected the responses to the choice scenarios, the oncologist characteristics and their usual prescriptions of G-CSFs in the context of breast, lungs and gastrointestinal cancers.

Results: Overall, the responses from 205 physicians were analysed. The physicians were mainly male (61%), with ≤20 years of experience (76%) and working only in public hospitals (73%). The physicians prescribe G-CSF primary prophylaxis for 32% of patients: filgrastim in 46% and pegfilgrastim in 54%. The choice of G-CSF for primary and secondary prophylaxis was driven by cost and number of injections. Biosimilars were well accepted.

Conclusion: Cost and convenience of G-CSF drive the physician decision to prescribe or not G-CSF for primary and secondary FN prophylaxes. It is important that these results be incorporated in the optimisation of G-CSF prescription in the clinical setting.

Keywords: cancer; hospital care; supportive care; symptoms and symptom management.

Figure 1. Analysis of the physicians’ preferences for G-CSF as primary (A) and secondary (B) prophylaxes. (A) Analysis of G-CSF preference for primary prophylaxis. (B) Analysis of G-CSF preference for secondary prophylaxis. FN, febrile neutropenia; G-CSF, granulocyte colony-stimulating factor.

Figure 2. Analysis of the G-CSF preference, as primary and secondary prophylaxes, according to the healthcare sector in which the physicians work. (A) Physicians working in the public sectors: primary prophylaxis preference; (B) physicians working in the private sector (combined or not with the public sector): primary prophylaxis preference; (C) physicians working in the public sectors: secondary prophylaxis preference; (D) physicians working in the private sector (combined or not with the public sector): secondary prophylaxis preference. FN, febrile neutropenia; G-CSF, granulocyte colony-stimulating factor.