title: Cost-utility analysis of primary prophylaxis versus secondary prophylaxis with granulocyte colony-stimulating factor in elderly patients with diffuse aggressive lymphoma receiving curative-intent chemotherapy.
abstract: OBJECTIVE
  The 2006 American Society of Clinical Oncology (ASCO) guideline recommended primary prophylaxis (PP) with granulocyte colony-stimulating factor (G-CSF) instead of secondary prophylaxis (SP) for elderly patients with diffuse aggressive lymphoma receiving chemotherapy. We examined the cost-effectiveness of PP when compared with SP.
  
  
  METHODS
  We conducted a cost-utility analysis to compare PP to SP for diffuse aggressive lymphoma. We used a Markov model with an eight-cycle chemotherapy time horizon with a government-payer perspective and Ontario health, economic, and cost data. Data for efficacies of G-CSF, probabilities, and utilities were obtained from published literature. Probabilistic sensitivity analysis (PSA) was conducted.
  
  
  RESULTS
  The incremental cost-effectiveness ratio of PP to SP was $700,500 per quality-adjusted life-year (QALY). One-way sensitivity analyses (willingness-to-pay threshold = $100,000/QALY) showed that if PP were to be cost-effective, the cost of hospitalization for febrile neutropenia (FN) had to be more than $31,138 (2.5 × > base case), the cost of G-CSF per cycle less than $960 (base case = $1,960), the risk of first-cycle FN more than 47% (base case = 24%), or the relative risk reduction of FN with G-CSF more than 91% (base case = 41%). Our result was robust to all variables. PSA revealed a 10% probability of PP being cost-effective over SP at a willingness-to-pay threshold of $100,000/QALY.
  
  
  CONCLUSIONS
  PP is not cost-effective when compared with SP in this population. PP becomes attractive only if the cost of hospitalization for FN is significantly higher or the cost of G-CSF is significantly lower.
authors.affiliation: Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. Kelvin.chan@sunnybrook.ca
authors.forename: Kelvin K W
authors.initials: KK
authors.lastname: Chan
authors.forename: Eric
authors.initials: E
authors.lastname: Siu
authors.forename: Murray D
authors.initials: MD
authors.lastname: Krahn
authors.forename: Kevin
authors.initials: K
authors.lastname: Imrie
authors.forename: Shabbir M H
authors.initials: SM
authors.lastname: Alibhai
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000191:economics*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009864:Ontario; D011322:Primary Prevention / Q000191:economics* / Q000379:methods; D019057:Quality-Adjusted Life Years; D055502:Secondary Prevention / Q000191:economics* / Q000379:methods; D016896:Treatment Outcome
chemical_list: D016179:Granulocyte Colony-Stimulating Factor