title: Cost-effectiveness of primary versus secondary prophylaxis with pegfilgrastim in women with early-stage breast cancer receiving chemotherapy.
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 >or=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.
authors.affiliation: Public Health Sciences Division, Fred Hutchinson Cancer Research Center and University of Washington Department of Medicine, Seattle, WA 98109, USA. sramsey@fhcrc.org
authors.forename: Scott D
authors.initials: SD
authors.lastname: Ramsey
authors.forename: Zhimei
authors.initials: Z
authors.lastname: Liu
authors.forename: Rob
authors.initials: R
authors.lastname: Boer
authors.forename: Sean D
authors.initials: SD
authors.lastname: Sullivan
authors.forename: Jennifer
authors.initials: J
authors.lastname: Malin
authors.forename: Quan V
authors.initials: QV
authors.lastname: Doan
authors.forename: Robert W
authors.initials: RW
authors.lastname: Dubois
authors.forename: Gary H
authors.initials: GH
authors.lastname: Lyman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D003362:Cost-Benefit Analysis; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D005334:Fever / Q000139:chemically induced / Q000191:economics / Q000517:prevention & control; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000191:economics* / Q000627:therapeutic use; D017048:Health Care Costs; D006801:Humans; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced / Q000191:economics / Q000401:mortality / Q000517:prevention & control*; D011092:Polyethylene Glycols; D011322:Primary Prevention / Q000191:economics*; D011336:Probability; D019057:Quality-Adjusted Life Years; D011994:Recombinant Proteins; D012306:Risk; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D055502:Secondary Prevention / Q000191:economics*; D014481:United States
chemical_list: D000970:Antineoplastic Agents; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; C455861:pegfilgrastim; D011092:Polyethylene Glycols; D000069585:Filgrastim