Reducing overuse of colony-Stimulating factors in patients with lung cancer receiving chemotherapy: Evidence from a decision support-enabled program

Purpose Colony-stimulating factors (CSFs) are frequently overused for the primary prevention of febrile neutropenia (FN) in patients receiving chemotherapy. Methods A retrospective cohort study design was used to analyze commercial claims data in adults with lung cancer initiated on chemotherapy from April 1, 2013, toMarch30, 2015. The tool was implemented at oncology practices in phases across 14 US states. Patients were assigned to intervention and nonintervention states according to whether they resided in service areaswherethe tool had beenimplemented. Patientswerefollowedupto6months after initiating chemotherapy. Difference in pre-And postimplementation CSF use and FN incidence rates were compared with the use of difference-in-differences (DID) models that were adjusted for baseline FN risk factors. Results The study population of 3,467 patients (intervention states: pre, 707; post, 1,150; nonintervention states: pre, 636; post, 974) showed no significant differences in FN risk factors at baseline. In adjusted results before and after implementation, CSFuse decreased from 48.4% to 35.6% in the intervention states versus 43.2% to 44.4% in the nonintervention states (DID,28.7%; 95% CI,214.65% to22.67%; P#.001). The rates of FN were consistent for both groups in both periods, with no statistical difference in trend for the intervention (2.8% to 4.3%) versus the nonintervention (3.1% to 5.1%) states (DID, 20.13; 95% CI, 20.35 to 0.10; P = .927). Conclusion These findings demonstrate that a decision support-enabled utilization management tool can improve risk-Appropriate, guideline-Adherent CSF use in patients with lung cancer.