title: Cost-effectiveness of filgrastim and pegfilgrastim as primary prophylaxis against febrile neutropenia in lymphoma patients.
abstract: BACKGROUND
  Febrile neutropenia is a serious toxicity of cancer chemotherapy that is usually treated in hospital. We assessed the cost-effectiveness of filgrastim and pegfilgrastim as primary prophylaxis against febrile neutropenia in diffuse large B-cell lymphoma (DLBCL) patients undergoing chemotherapy.
  
  
  METHODS
  We used a Markov model that followed patients through induction chemotherapy to compare the three prophylaxis strategies: 1) no primary prophylaxis against febrile neutropenia; 2) primary prophylaxis with 10 days of filgrastim therapy; and 3) primary prophylaxis with a single dose of pegfilgrastim. The target population was a hypothetical cohort of 64-year-old men and women with DLBCL. Data sources included published literature and current clinical practice. The analysis was conducted from a publicly funded health-care system perspective. The main outcome measures included costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs).
  
  
  RESULTS
  In the base-case analysis, costs associated with no primary prophylaxis, primary prophylaxis with 10 days of filgrastim, and primary prophylaxis with pegfilgrastim were CaD $7314, CaD $13947, and CaD $16290, respectively. The QALYs associated with the three strategies were 0.2004, 0.2015, and 0.2024, respectively. The ICER for the filgrastim vs no primary prophylaxis strategy was CaD $5796000 per QALY. The ICER for the pegfilgrastim vs filgrastim primary prophylaxis strategy was CaD $2611000 per QALY. All one-way sensitivity analyses yielded ICERs greater than CaD $400000 per QALY. Cost-effectiveness acceptability curves show that 20.0% of iterations are cost-effective at a willingness-to-pay threshold of CaD $1595000 for the filgrastim strategy and CaD $561000 for the pegfilgrastim strategy.
  
  
  CONCLUSIONS
  Primary prophylaxis against febrile neutropenia with either filgrastim or pegfilgrastim is not cost-effective in DLBCL patients.
authors.affiliation: Department of Pharmaceutical Sciences, University of Toronto, Toronto, Ontario, Canada. nina.lathia@sunnybrook.ca
authors.forename: Nina
authors.initials: N
authors.lastname: Lathia
authors.forename: Pierre K
authors.initials: PK
authors.lastname: Isogai
authors.forename: Carlo
authors.initials: C
authors.lastname: De Angelis
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Smith
authors.forename: Matthew
authors.initials: M
authors.lastname: Cheung
authors.forename: Nicole
authors.initials: N
authors.lastname: Mittmann
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Hoch
authors.forename: Scott
authors.initials: S
authors.lastname: Walker
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D005334:Fever / Q000209:etiology*; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage / Q000627:therapeutic use*; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D008223:Lymphoma / Q000188:drug therapy*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced / Q000150:complications / Q000191:economics / Q000517:prevention & control*; D016017:Odds Ratio; D011092:Polyethylene Glycols; D011322:Primary Prevention / Q000191:economics* / Q000379:methods; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D017211:Treatment Failure
chemical_list: D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; C455861:pegfilgrastim; D011092:Polyethylene Glycols; D000069585:Filgrastim