Economic analysis of prophylactic pegfilgrastim in adult cancer patients receiving chemotherapy.
OBJECTIVE
Neutropenia and its complications, including febrile neutropenia (FN), are a common side effect of cancer chemotherapy. Results of clinical trials showed that prophylactic use of granulocyte colony-stimulating factors (G-CSF) is effective in preventing FN. In this study, the cost effectiveness (measured as cost per quality-adjusted time [days]) of three treatment alternatives were evaluated: no G-CSF, filgrastim administered daily for 7-12 days after chemotherapy, and a pegylated form of G-CSF pegfilgrastim, administered once per cycle.


METHODS
A cost-utility model based on standard clinical practice of treating FN with immediate hospitalization or with ambulatory treatment, from a societal perspective was developed. Direct medical cost estimates for hospitalization were derived from claims data reported by 115 US academic medical centers. Indirect medical costs, productivity costs, probabilities, and utilities are based on published literature. Results were subjected to sensitivity analyses and 95% confidence intervals are based on a Monte Carlo simulation.


RESULTS
Mean estimated costs/day of hospitalization were $1984 (SD $1040, N = 24,687) for surviving patients and $3139 (SD $2014, N = 1437) for dying patients. Under baseline conditions, pegfilgrastim dominated both filgrastim and no G-CSF, with expected costs and effectiveness of $4203 and 12.361 quality adjusted life-days (QALDs) for no G-CSF, $3058 and 12.967 QALDs for pegfilgrastim, and $5264 and 12.698 QALDs for filgrastim.


CONCLUSIONS
This cost-utility analysis provides strong evidence that pegfilgrastim is not only cost-effective but also cost-saving in most common clinical and economic settings. There appear to be both clinical and economic benefits from prophylactic administration of pegfilgrastim.
Eldar-Lissai
Adi
A
Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
Cosler
Leon E
LE
Culakova
Eva
E
Lyman
Gary H
GH
D000328:Adult; D000368:Aged; D000465:Algorithms; D000553:Ambulatory Care / Q000191:economics*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D003115:Colony-Stimulating Factors / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000191:economics* / Q000627:therapeutic use; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D018803:Models, Economic; D009503:Neutropenia / Q000150:complications / Q000188:drug therapy*; D011092:Polyethylene Glycols; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins
D003115:Colony-Stimulating Factors; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; C455861:pegfilgrastim; D011092:Polyethylene Glycols; D000069585:Filgrastim