Aim: The use of Granulocyte-colony stimulator factors (G-CSF) has increased across the Western NSW Local Health District (LHD). This project aimed to evaluate the impact of G-CSF prescribing tendencies and dosing in neutropenic sepsis on treatment duration and cost to the health system.
Methods: A clinical audit of the use of G-CSF in 3 locations across the LHD was undertaken over the period March 2019 – November 2019. Filgrastim and pegfilgrastim for prescription and dosage rates were collected from Electronic medical prescribing (eMeds) software. The audit indicated that 45 patient encounters met the inclusion criteria. A quantitative analysis was undertaken to assess the appropriateness of medication choice, dose as well as a cost-benefit analysis.
Results: 93.3% of patients received filgrastim. Of the patients included, 37 patients (83.3%) had their weight recorded. Just over half of these patients (57%) received a dose that was correct for their weight. G-CSF was given until the absolute neutrophil count (ANC) was at least 1.0x109. The Cost of G-CSF to achieve an ANC of at least 1.0 was higher for those who were sub-optimally dosed ($67.80 and $41.37 respectively). The total number of days of treatment was significantly less when G-CSF was optimally dosed for body weight (2.25 days v. 3.82 days), which also correlated with a reduction in length of admission (8.44 days v 9.11 days).
Conclusion: G-CSF is the gold standard in conjunction with antibiotics for the management of neutropenic sepsis. The total duration of G-CSF treatment and the length of admission were reduced when G-CSF was dosed correctly based on patient body weight with regard to patients’ ANC. These results indicate that whilst the G-CSF being prescribed is in line with current guidelines, there is a tendency to underdose, which is associated with longer, more expensive hospital admissions.