Economic evaluation of filgrastim, sargramostim, and sequential sargramostim and filgrastim after myelosuppressive chemotherapy.

Filgrastim alone and sequential sargramostim and filgrastim have been shown to be more effective than sargramostim alone in the mobilization of CD34(+) cells after myelosuppressive chemotherapy (MC). We sought to compare costs and resource use associated with these regimens. Data were collected prospectively alongside a multicenter, randomized trial of filgrastim, sargramostim, and sequential sargramostim and filgrastim. Direct medical costs were calculated for inpatient and outpatient visits and procedures, including administration of growth factors and MC. We followed 156 patients for 30 days or until initiation of high-dose chemotherapy. The main outcome measures were resource use and costs of inpatient and outpatient visits, platelet and red blood cell transfusions, antibiotic use, and apheresis procedures. Hospital admissions, red blood cell transfusions, and use of i.v. antibiotics were significantly more common in the sargramostim group than in the other treatment arms. In univariate and multivariable analyses, total costs were higher for patients receiving sargramostim alone than for patients in the other groups. Mean costs in multivariable analysis for the filgrastim and sequential sargramostim and filgrastim arms were not significantly different. Filgrastim alone and sequential sargramostim and filgrastim are less costly than sargramostim alone after MC, as well as therapeutically more beneficial.

Predicting the need for intraoperative cholangiography after cholecystectomy.

A decision tree based on the common clinical indicators seen in acute and chronic cholecystitis is presented. The use of such a decision tree aids in the selective, rather than the routine, use of intraoperative cholangiography. In this series, the number of intraoperative cholangiograms could have been decreased from 275 to 101 by using the decision tree. At the same time, the number of negative explorations could have been reduced from 13 to 7, while the number of positive explorations would remain the same. The decision tree provides a systematic approach to the use of intraoperative cholangiography, thereby saving operating time and cost. By using this approach, the surgeon can not only select those patients in whom intraoperative cholangiogram will be useful in determining the need for exploration of the common duct and finding the unexpected common duct stone, but also eliminate [corrected] its use in those patients who have no clinical indications.