Objective. To report a case where both pegfilgrastim and filgrastim were considered in the treatment of febrile neutropenia in a hospitalized patient and assess the most cost-effective option.
Case summary. A 77-year-old white female was diagnosed with squamous cell carcinoma of the anus and adjuvant chemotherapy was ordered. She subsequently developed Grade 4 neutropenia, a wound infection and her Eastern Cooperative Oncology Group (ECOG) performance status declined to 4. Antibiotics were started and growth factor therapy was considered as part of her treatment. Filgrastim 480 g subcutaneously every day was chosen and her absolute neutrophil count (ANC) recovered after seven days of therapy.
Discussion. This case illustrates the potential cost benefits of using filgrastim over pegfilgrastim in hospitalized patients. The choice of filgrastim in our patient resulted in only seven days of filgrastim therapy at a cost of $2205.70. A 6 mg dose of pegfilgrastim is priced similarly to 10 days of filgrastim 480 g, therefore a cost savings of $744.01 was realized in our patient.
Conclusions. Filgrastim is the most appropriate growth factor for the treatment of established high-risk febrile neutropenia given that the ANC can be monitored on a daily basis and therapy can be discontinued upon recovery.
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