Cost-Effectiveness of Primary versus Secondary Prophylaxis with Pegfilgrastim in Women with Early-Stage Breast Cancer Receiving Chemotherapy |
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Authors: | Scott D Ramsey MD PhD Zhimei Liu PhD Rob Boer PhD Sean D Sullivan PhD Jennifer Malin MD PhD Quan V Doan PharmD Robert W Dubois MD PhD Gary H Lyman MD MPH FRCP |
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Institution: | Fred Hutchinson Cancer Research Center and University of Washington Department of Medicine, Seattle, WA, USA;;Cerner LifeSciences, Beverly Hills, CA, USA;;Consultant to Amgen, Santa Monica, CA, USA;;University of Washington School of Pharmacy, Seattle, WA, USA;;JAmgen Inc., Thousand Oaks, CA, USA;;Duke University and the Duke Comprehensive Cancer Center, Durham, NC, USA |
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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. |
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Keywords: | breast cancer cost-effectiveness pegfilgrastim primary prophylaxis |
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