Cost Effectiveness of Primary Pegfilgrastim Prophylaxis in Patients With Breast Cancer at Risk of Febrile Neutropenia

Maureen J. Aarts, Janneke P. Grutters, Frank P. J. Peters, Caroline M. Mandigers, M. Wouter Dercksen, Jacqueline M. Stouthard, Hans J. Nortier, Hanneke W. van Laarhoven, Laurence J. C. van Warmerdam, Agnes J. van de Wouw, Esther M. Jacobs, Vera Mattijssen, Carin C. van der Rijt, Tineke J. Smilde, Annette W. van der Velden, Mehmet Temizkan, Erdogan Batman, Erik W. Muller, Saskia M. van Gastel, Manuela A. JooreGeorge F. Borm, Vivianne C. Tjan-Heijnen*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

29 Citations (Web of Science)

Abstract

Purpose Guidelines advise primary granulocyte colony-stimulating factor (G-CSF) prophylaxis during chemotherapy if risk of febrile neutropenia (FN) is more than 20%, but this comes with considerable costs. We investigated the incremental costs and effects between two treatment strategies of primary pegfilgrastim prophylaxis. Methods Our economic evaluation used a health care perspective and was based on a randomized study in patients with breast cancer with increased risk of FN, comparing primary G-CSF prophylaxis throughout all chemotherapy cycles (G-CSF 1-6 cycles) with prophylaxis during the first two cycles only (G-CSF 1-2 cycles). Primary outcome was cost effectiveness expressed as costs per patient with episodes of FN prevented. Results The incidence of FN increased from 10% in the G-CSF 1 to 6 cycles study arm (eight of 84 patients) to 36% in the G-CSF 1 to 2 cycles study arm (30 of 83 patients), whereas the mean total costs decreased from Euro 20,658 (95% CI, Euro 20,049 to Euro 21,247) to Euro 17,168 (95% CI Euro 16,239 to Euro 18,029) per patient, respectively. Chemotherapy and G-CSF determined 80% of the total costs. As expected, FN-related costs were higher in the G-CSF 1 to 2 cycles arm. The incremental cost effectiveness ratio for the G-CSF 1 to 6 cycles arm compared with the G-CSF 1 to 2 cycles arm was Euro 13,112 per patient with episodes of FN prevented. Conclusion We conclude that G-CSF prophylaxis throughout all chemotherapy cycles is more effective, but more costly, compared with prophylaxis limited to the first two cycles. Whether G-CSF prophylaxis throughout all chemotherapy cycles is considered cost effective depends on the willingness to pay per patient with episodes of FN prevented.
Original languageEnglish
Pages (from-to)4283-4289
JournalJournal of Clinical Oncology
Volume31
Issue number34
DOIs
Publication statusPublished - 1 Dec 2013

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