title: Cost-effectiveness of granulocyte colony-stimulating factor prophylaxis for febrile neutropenia in breast cancer in the United Kingdom.
abstract: OBJECTIVE
  We report a cost-effectiveness evaluation of granulocyte colony-stimulating factors (G-CSFs) for the prevention of febrile neutropenia (FN) after chemotherapy in the United Kingdom (UK).
  
  
  METHODS
  A mathematical model was constructed simulating the experience of women with breast cancer undergoing chemotherapy. Three strategies were modeled: primary prophylaxis (G-CSFs administered in all cycles), secondary prophylaxis (G-CSFs administered in all cycles after an FN event), and no G-CSF prophylaxis. Three G-CSFs were considered: filgrastim, lenograstim, and pegfilgrastim. Costs were taken from UK databases and utility values from published sources. A systematic review provided data on G-CSF efficacy. Probabilistic sensitivity analyses examined the effects of uncertainty in model parameters.
  
  
  RESULTS
  In the UK, base-case analysis with a willingness-to-pay (WTP) threshold of £20K per quality-adjusted life year gained and also using list prices, the most cost-effective strategy was primary prophylaxis with pegfilgrastim for a patient with baseline FN risk greater than 38%, secondary prophylaxis with pegfilgrastim for baseline FN risk 11% to 37%, and no G-CSFs for baseline FN risk less than 11%. Using a WTP threshold of £30K and list prices, primary prophylaxis with pegfilgrastim was cost-effective for baseline FN risks greater than 29%. In all analyses, pegfilgrastim dominated filgrastim and lenograstim. Sensitivity analyses demonstrated that higher WTP threshold, younger age, earlier stage at diagnosis, or reduced G-CSF prices result in G-CSF prophylaxis being cost-effective at lower baseline FN risk levels.
  
  
  CONCLUSIONS
  Pegfilgrastim was the most cost-effective G-CSF. The most cost-effective strategy (primary or secondary prophylaxis) was dependent on the FN risk level for an individual patient, patient age and stage at diagnosis, and G-CSF price.
authors.affiliation: University of Sheffield, Sheffield, UK. sophie.whyte@sheffield.ac.uk
authors.forename: Sophie
authors.initials: S
authors.lastname: Whyte
authors.forename: Katy L
authors.initials: KL
authors.lastname: Cooper
authors.forename: Matt D
authors.initials: MD
authors.lastname: Stevenson
authors.forename: Jason
authors.initials: J
authors.lastname: Madan
authors.forename: Ron
authors.initials: R
authors.lastname: Akehurst
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D003362:Cost-Benefit Analysis / Q000191:economics; D005260:Female; D005334:Fever / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage / Q000191:economics*; D006801:Humans; D008875:Middle Aged; D018803:Models, Economic; D009503:Neutropenia / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D016179:Granulocyte Colony-Stimulating Factor