title: Cost effectiveness of primary pegfilgrastim prophylaxis in patients with breast cancer at risk of febrile neutropenia.
abstract: OBJECTIVE
  Guidelines advise primary granulocyte colony-stimulating factor (G-CSF) prophylaxis during chemotherapy if risk of febrile neutropenia (FN) is more than 20%, but this comes with considerable costs. We investigated the incremental costs and effects between two treatment strategies of primary pegfilgrastim prophylaxis.
  
  
  METHODS
  Our economic evaluation used a health care perspective and was based on a randomized study in patients with breast cancer with increased risk of FN, comparing primary G-CSF prophylaxis throughout all chemotherapy cycles (G-CSF 1-6 cycles) with prophylaxis during the first two cycles only (G-CSF 1-2 cycles). Primary outcome was cost effectiveness expressed as costs per patient with episodes of FN prevented.
  
  
  RESULTS
  The incidence of FN increased from 10% in the G-CSF 1 to 6 cycles study arm (eight of 84 patients) to 36% in the G-CSF 1 to 2 cycles study arm (30 of 83 patients), whereas the mean total costs decreased from € 20,658 (95% CI, € 20,049 to € 21,247) to € 17,168 (95% CI € 16,239 to € 18,029) per patient, respectively. Chemotherapy and G-CSF determined 80% of the total costs. As expected, FN-related costs were higher in the G-CSF 1 to 2 cycles arm. The incremental cost effectiveness ratio for the G-CSF 1 to 6 cycles arm compared with the G-CSF 1 to 2 cycles arm was € 13,112 per patient with episodes of FN prevented.
  
  
  CONCLUSIONS
  We conclude that G-CSF prophylaxis throughout all chemotherapy cycles is more effective, but more costly, compared with prophylaxis limited to the first two cycles. Whether G-CSF prophylaxis throughout all chemotherapy cycles is considered cost effective depends on the willingness to pay per patient with episodes of FN prevented.
authors.affiliation: Maureen J. Aarts, Vivianne C. Tjan-Heijnen, Janneke P. Grutters, Manuela A. Joore, Maastricht University Medical Center, Maastricht; Frank P. Peters, Orbis Medical Centre, Sittard; Caroline M. Mandigers, Canisius Wilhelmina Hospital, Nijmegen; M. Wouter Dercksen, Maxima Medical Center, Veldhoven; Jacqueline M. Stouthard, Maasstad Medical Center, Rotterdam; Hans J. Nortier, Leiden University Medical Center, Leiden; Hanneke W. van Laarhoven, George F. Borm, Radboud University Nijmegen Medical Centre, Nijmegen; Laurence J. van Warmerdam, Catharina Hospital, Eindhoven; Agnes J. van de Wouw, VieCuri Medical Center, Venlo; Esther M. Jacobs, Elkerliek Hospital, Helmond; Vera Mattijssen, Rijnstate Hospital, Arnhem; Carin C. van der Rijt, Erasmus Medical Center Daniel den Hoed Cancer Center, Rotterdam; Tineke J. Smilde, Jeroen Bosch Hospital, 's-Hertogenbosch; Annette W. van der Velden, Martini Hospital, Groningen; Mehmet Temizkan, Hospital St Jansdal, Harderwijk; Erdogan Batman, Diaconessenhuis Leiden, Leiden; Erik W. Muller, Slingeland Hospital, Doetinchem; Saskia M. van Gastel, Comprehensive Cancer Center East, Nijmegen the Netherlands.
authors.forename: Maureen J
authors.initials: MJ
authors.lastname: Aarts
authors.forename: Janneke P
authors.initials: JP
authors.lastname: Grutters
authors.forename: Frank P
authors.initials: FP
authors.lastname: Peters
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Mandigers
authors.forename: M Wouter
authors.initials: MW
authors.lastname: Dercksen
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Stouthard
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Nortier
authors.forename: Hanneke W
authors.initials: HW
authors.lastname: van Laarhoven
authors.forename: Laurence J
authors.initials: LJ
authors.lastname: van Warmerdam
authors.forename: Agnes J
authors.initials: AJ
authors.lastname: van de Wouw
authors.forename: Esther M
authors.initials: EM
authors.lastname: Jacobs
authors.forename: Vera
authors.initials: V
authors.lastname: Mattijssen
authors.forename: Carin C
authors.initials: CC
authors.lastname: van der Rijt
authors.forename: Tineke J
authors.initials: TJ
authors.lastname: Smilde
authors.forename: Annette W
authors.initials: AW
authors.lastname: van der Velden
authors.forename: Mehmet
authors.initials: M
authors.lastname: Temizkan
authors.forename: Erdogan
authors.initials: E
authors.lastname: Batman
authors.forename: Erik W
authors.initials: EW
authors.lastname: Muller
authors.forename: Saskia M
authors.initials: SM
authors.lastname: van Gastel
authors.forename: Manuela A
authors.initials: MA
authors.lastname: Joore
authors.forename: George F
authors.initials: GF
authors.lastname: Borm
authors.forename: Vivianne C
authors.initials: VC
authors.lastname: Tjan-Heijnen
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000191:economics; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D016527:Drug Costs; D064147:Febrile Neutropenia / Q000139:chemically induced / Q000191:economics / Q000517:prevention & control*; D005260:Female; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D018803:Models, Economic; D009426:Netherlands; D011092:Polyethylene Glycols; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; C455861:pegfilgrastim; D011092:Polyethylene Glycols; D000069585:Filgrastim