Comparison of Pegfilgrastim Prescribing Practice to National Guidelines at a University Hospital Outpatient Oncology Clinic

Purpose: Pegfilgrastim reduces the risk of febrile neutropenia (FN) and is indicated as primary prophylaxis when the risk of FN approaches 20% in each chemotherapy cycle. There have been few reports evaluating the appropriate use of pegfilgrastim in comparison with published guidelines. We sought to determine possible over-prescribing as a way to maintain quality and reduce cost.

Methods: A retrospective medical record review was performed to determine whether pegfilgrastim was used appropriately in the primary prophylaxis of FN in chemotherapy regimens with less than 20% risk of FN. Patients were identified by means of administrative records, and data were collected from the electronic medical record at an academic cancer center outpatient clinic serving approximately 13,000 patients per year.

Results: Two hundred ninety-two patients were identified, of whom 124 were initially evaluated and 88 were included. Thirty-three patients (37%) had no risk factors, and 20 (22%) had one risk factor that would justify pegfilgrastim use with low- or intermediate-risk regimens. The most common cancer diagnosis of patients with zero or one risk factor was lymphoma, and the most common regimens with overuse of pegfilgrastim were doxorubicin-bleomycin-vinblastine-dacarbazine (ABVD) and ritux-imab-cyclophosphamide-doxorubicin-vincristine-prednisone (R-CHOP). One hundred eighty-four pegfilgrastim doses (46%) were classified as avoidable. The cost to the health system for unnecessary drug use was $712,264 in 1 year.

Conclusion: At one institution, approximately one half of all primary prophylaxis pegfilgrastim was not indicated per published guidelines. This represents an excellent opportunity to change prescribing practices to reduce costs without harming patients.