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

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

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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 effe 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. (C) 2013 by American Society of Clinical Oncology
Original languageUndefined/Unknown
Pages (from-to)4283-4289
Number of pages7
JournalJournal of Clinical Oncology
Issue number34
Publication statusPublished - 2013

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  • EMC OR-01-86-13

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