[Pegfilgrastim vs filgrastim in primary prophylaxis of febrile neutropenia in patients with breast cancer after chemotherapy: a cost-effectiveness analysis for Germany].
OBJECTIVE
Febrile neutropenia (FN) is a common toxic side effect of myelosuppressive chemotherapy. The cost-effectiveness of primary prophylaxis (PP) of FN with granulocyte colony stimulating growth factor (G-CSF) filgrastim for six or eleven days was compared to single dose pegfilgrastim in patients with early breast cancer receiving chemotherapy (>or= 20 % FN risk) as simulated in a model.


METHODS
Based on a decision-analytical model we conducted a cost-effectiveness analysis (CEA) and a cost-utility analysis (CUA) from the perspective of the Statutory Health Insurance (SHI) in Germany. The model simulated three clinical alternatives being built on each other, that pegfilgrastim and filgrastim had differential impact on (1) the risk of FN, (2) on FN-related mortality, and (3) on the achieved chemotherapy relative dose intensity (RDI) leading to gain in long-term survival.


RESULTS
Assuming a 5.5 % lower risk of FN for PP with pegfilgrastim than an 11-day course of filgrastim provided - from the perspective of the SHI - a cost saving of Euro 2,229. A gain of 0.039 quality-adjusted life-years (QALY) resulted when the third alternative was used. Assuming a 10.5 % lower risk of FN for PP with pegfilgrastim than a 6-day filgrastim course, the third alternative showed an incremental cost-effectiveness ratio (ICER) of Euro 17.165 per life-year gained (LYG) and Euro 18.324 per QALY with 0.074 QALYs gained.


CONCLUSIONS
These results indicate that PP with pegfilgrastim is cost saving compared to 11-day use of filgrastim and cost-effective compared to 6-day use of filgrastim in patients with breast cancer treated in Germany.
Sehouli
J
J
Charité/Campus Virchow-Klinikum, Klinik für Gynäkologie, Universitätsmedizin Berlin.
Goertz
A
A
Steinle
T
T
Dubois
R
R
Plesnila-Frank
C
C
Lalla
A
A
von Minckwitz
G
G
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000276:immunology / Q000473:pathology; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D016527:Drug Costs / Q000706:statistics & numerical data*; D005260:Female; D005335:Fever of Unknown Origin / Q000139:chemically induced* / Q000191:economics / Q000517:prevention & control*; D000069585:Filgrastim; D005858:Germany; D016179:Granulocyte Colony-Stimulating Factor / Q000191:economics* / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics*; D009367:Neoplasm Staging; D009503:Neutropenia / Q000139:chemically induced* / Q000191:economics / Q000517:prevention & control*; D011092:Polyethylene Glycols; D019057:Quality-Adjusted Life Years; D011994:Recombinant Proteins; D016019:Survival Analysis
D000970:Antineoplastic Agents; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; C455861:pegfilgrastim; D011092:Polyethylene Glycols; D000069585:Filgrastim