COST EFFECTIVENESS OF NEULASTA

J Clin Oncol. 2013 Oct 28. [Epub ahead of print]

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

Aarts MJ, Grutters JP, Peters FP, Mandigers CM, Dercksen MW, Stouthard JM, Nortier HJ, van Laarhoven HW, van Warmerdam LJ, van de Wouw AJ, Jacobs EM, Mattijssen V, van der Rijt CC, Smilde TJ, van der Velden AW, Temizkan M, Batman E, Muller EW, van Gastel SM, Joore MA, Borm GF, Tjan-Heijnen VC.

Source

Maureen J. Aarts, Vivianne C. Tjan-Heijnen, Janneke P. Grutters, Manuela A. Joore, Maastricht University Medical Center, Maastricht; Frank P. Peters, Orbis Medical Centre, Sittard; Caroline M. Mandigers, Canisius Wilhelmina Hospital, Nijmegen; M. Wouter Dercksen, Maxima Medical Center, Veldhoven; Jacqueline M. Stouthard, Maasstad Medical Center, Rotterdam; Hans J. Nortier, Leiden University Medical Center, Leiden; Hanneke W. van Laarhoven, George F. Borm, Radboud University Nijmegen Medical Centre, Nijmegen; Laurence J. van Warmerdam, Catharina Hospital, Eindhoven; Agnes J. van de Wouw, VieCuri Medical Center, Venlo; Esther M. Jacobs, Elkerliek Hospital, Helmond; Vera Mattijssen, Rijnstate Hospital, Arnhem; Carin C. van der Rijt, Erasmus Medical Center Daniel den Hoed Cancer Center, Rotterdam; Tineke J. Smilde, Jeroen Bosch Hospital, 's-Hertogenbosch; Annette W. van der Velden, Martini Hospital, Groningen; Mehmet Temizkan, Hospital St Jansdal, Harderwijk; Erdogan Batman, Diaconessenhuis Leiden, Leiden; Erik W. Muller, Slingeland Hospital, Doetinchem; Saskia M. van Gastel, Comprehensive Cancer Center East, Nijmegen the Netherlands.

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 € 20,658 (95% CI, € 20,049 to € 21,247) to € 17,168 (95% CI € 16,239 to € 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 € 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.