title: Cost-effectiveness of prophylaxis treatment strategies for febrile neutropenia in patients with recurrent ovarian cancer.
abstract: OBJECTIVE
  Evaluate the cost-effectiveness of primary prophylaxis (PP) or secondary prophylaxis (SP) with pegfilgrastim, filgrastim (6-day and 11-day), or no prophylaxis to reduce the risk of febrile neutropenia (FN) in patients with recurrent ovarian cancer receiving docetaxel or topotecan.
  
  
  METHODS
  A Markov model was used to evaluate the cost-effectiveness of PP vs SP from a US payer perspective. Model inputs, including the efficacy of each strategy (relative risk of FN with prophylaxis compared to no prophylaxis) and mortality, costs, and utility values were estimated from public sources and peer-reviewed publications. Incremental cost-effectiveness was evaluated in terms of net cost per FN event avoided, incremental cost per life-year saved (LYS), and incremental cost per quality-adjusted life-year (QALY) gained over a lifetime horizon. Deterministic and probabilistic sensitivity analyses (DSA and PSA) were conducted.
  
  
  RESULTS
  For patients receiving docetaxel, the incremental cost-effectiveness ratio (ICER) for PP vs SP with pegfilgrastim was $7900 per QALY gained, and PP with pegfilgrastim dominated all other comparators. For patients receiving topotecan, PP with pegfilgrastim dominated all comparators. Model results were most sensitive to baseline FN risk. PP vs SP with pegfilgrastim was cost effective in 68% and 83% of simulations for docetaxel and in >99% of simulations for topotecan at willingness-to-pay thresholds of $50,000 and $100,000 per QALY.
  
  
  CONCLUSIONS
  PP with pegfilgrastim should be considered cost effective compared to other prophylaxis strategies in patients with recurrent ovarian cancer receiving docetaxel or topotecan with a high risk of FN.
authors.affiliation: OptumInsight, Cambridge, MA, USA. Electronic address: kelly.fust@optum.com.
authors.forename: Kelly
authors.initials: K
authors.lastname: Fust
authors.affiliation: Amgen Inc., Thousand Oaks, CA, USA.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Li
authors.affiliation: OptumInsight, Burlington, ON, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Maschio
authors.affiliation: Amgen Inc., Thousand Oaks, CA, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Barron
authors.affiliation: OptumInsight, Cambridge, MA, USA; Harvard School of Public Health, Boston, MA, USA.
authors.forename: Milton C
authors.initials: MC
authors.lastname: Weinstein
authors.affiliation: OptumInsight, Cambridge, MA, USA.
authors.forename: Anju
authors.initials: A
authors.lastname: Parthan
authors.affiliation: OptumInsight, Burlington, ON, Canada.
authors.forename: Marjan
authors.initials: M
authors.lastname: Walli-Attaei
authors.affiliation: Amgen Inc., Thousand Oaks, CA, USA.
authors.forename: David B
authors.initials: DB
authors.lastname: Chandler
authors.affiliation: Duke University, Duke Cancer Institute, Durham, NC, USA.
authors.forename: Gary H
authors.initials: GH
authors.lastname: Lyman
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D000077216:Carcinoma, Ovarian Epithelial; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000209:etiology / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D000077143:Docetaxel; D016527:Drug Costs; D005260:Female; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy*; D010051:Ovarian Neoplasms / Q000188:drug therapy*; D011092:Polyethylene Glycols; D019057:Quality-Adjusted Life Years; D011994:Recombinant Proteins / Q000191:economics / Q000627:therapeutic use; D043823:Taxoids / Q000009:adverse effects; D019772:Topotecan / Q000009:adverse effects
chemical_list: D000970:Antineoplastic Agents; D011994:Recombinant Proteins; D043823:Taxoids; D016179:Granulocyte Colony-Stimulating Factor; D000077143:Docetaxel; C455861:pegfilgrastim; D011092:Polyethylene Glycols; D019772:Topotecan; D000069585:Filgrastim
keywords: Cost effectiveness; Febrile neutropenia; Filgrastim; Ovarian cancer; Pegfilgrastim; Prophylaxis