Cost-Effectiveness of Primary versus Secondary Prophylaxis with Pegfilgrastim in Women with Early-Stage Breast Cancer Receiving Chemotherapy

• Published in: Value in health Vol. 12; no. 2; pp. 217 - 225
• Main Authors: Ramsey, Scott D., MD, PhD, Liu, Zhimei, PhD, Boer, Rob, PhD, Sullivan, Sean D., PhD, Malin, Jennifer, MD, PhD, Doan, Quan V., PharmD, Dubois, Robert W., MD, PhD, Lyman, Gary H., MD, MPH, FRCP (Edin)
• Format: Journal Article
• Language: English
• Published: Malden, USA Elsevier Inc 01.03.2009; Blackwell Publishing Inc
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Agents - adverse effects; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - economics; Breast Neoplasms - mortality; Chemotherapy; Cost effectiveness; Cost-Benefit Analysis; Decision Making; Decision Support Techniques; Female; Fever - chemically induced; Fever - economics; Fever - prevention & control; Filgrastim; Granulocyte Colony-Stimulating Factor - economics; Granulocyte Colony-Stimulating Factor - therapeutic use; Health Care Costs; Humans; Internal Medicine; Middle Aged; Mortality; Neutropenia - chemically induced; Neutropenia - economics; Neutropenia - mortality; Neutropenia - prevention & control; pegfilgrastim; Polyethylene Glycols; Primary Prevention - economics; primary prophylaxis; Probability; Quality-Adjusted Life Years; Recombinant Proteins; Relative risks; Risk; Risk Assessment; Risk Factors; Risk Reduction Behavior; Secondary Prevention - economics; United States; Women; cost-effectiveness; breast cancer; pegfilgrastim; primary prophylaxis
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1111/j.1524-4733.2008.00434.x

Abstract Objective Prophylaxis with granulocyte colony-stimulating factor (G-CSF) reduces the risk of febrile neutropenia (FN) in patients receiving myelosuppressive chemotherapy. We estimated the incremental cost-effectiveness of G-CSF pegfilgrastim primary (starting in cycle 1 and continuing in subsequent cycles of chemotherapy) versus secondary (only after an FN event) prophylaxis in women with early-stage breast cancer receiving myelosuppressive chemotherapy with a ≥20% FN risk. Methods A decision-analytic model was constructed from a health insurer's perspective with a lifetime study horizon. The model considers direct medical costs and outcomes related to reduced FN and potential survival benefits because of reduced FN-related mortality. Inputs for the model were obtained from the medical literature. Sensitivity analyses were conducted across plausible ranges in parameter values. Results The incremental cost-effectiveness ratio (ICER) of pegfilgrastim as primary versus secondary prophylaxis was $48,000/FN episode avoided. Adding survival benefit from avoiding FN mortality yielded an ICER of $110,000/life-year gained (LYG) or $116,000/quality-adjusted life-year (QALY) gained. The most influential factors included FN case-fatality, FN relative risk reduction from primary prophylaxis, and age at diagnosis. Conclusions Compared with secondary prophylaxis, the cost-effectiveness of pegfilgrastim as primary prophylaxis may be equivalent or superior to other commonly used supportive care interventions for women with breast cancer. Further assessment of the direct impact of G-CSF on short- and long-term survival is needed to substantiate these findings.