title: Clinical Outcomes and Cost-effectiveness of Primary Prophylaxis of Febrile Neutropenia During Adjuvant Docetaxel and Cyclophosphamide Chemotherapy for Breast Cancer.
abstract: Docetaxel and cyclophosphamide (TC) is a widely used breast cancer adjuvant regimen. We sought to compare the rates of febrile neutropenia (FN) between patients receiving no primary prophylaxis (PP) and those receiving PP with either granulocyte-colony stimulating factor (G-CSF) or antibiotics. We also analyzed cost-effectiveness of TC with and without either G-CSF or antibiotics. Charts were reviewed of all 340 patients who received adjuvant TC between January 2008 and December 2012 at two major cancer centers. Rates of FN in the three groups - no PP, PP with G-CSF and PP with antibiotics were compared. A Markov model was constructed comparing cost-effectiveness of PP with G-CSF, PP with antibiotics, and secondary prophylaxis (SP) with G-CSF after an episode of FN in a previous cycle. Costs were based on actual resource utilization and supplemented by the published literature, adjusted to 2012 Canadian dollars. Of the 73 (21%) patients who did not receive any PP, 23 (32%) of patients developed FN. Of the 192 (57%) patients receiving PP with G-CSF alone, only two (1%; p < 0.0001) developed FN; and of the 53 (16%) receiving PP with antibiotics alone, six (11%; p < 0.01) developed FN. From a cost-standpoint, PP with G-CSF was less cost-effective than PP with antibiotics. The rate of FN with TC chemotherapy exceeds 30%, and American Society of Clinical Oncology guidelines recommend PP with G-CSF in this situation. PP with antibiotics is more cost-effective, and is a reasonable option in resource-limited settings or for patients who decline or do not tolerate G-CSF.
authors.affiliation: Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Joanne L
authors.initials: JL
authors.lastname: Yu
authors.affiliation: Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Kelvin
authors.initials: K
authors.lastname: Chan
authors.affiliation: Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Kurin
authors.affiliation: Sunnybrook Odette Cancer Centre Pharmacy, Toronto, Ontario, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Pasetka
authors.affiliation: Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada.
authors.forename: Alex
authors.initials: A
authors.lastname: Kiss
authors.affiliation: Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Srikala S
authors.initials: SS
authors.lastname: Sridhar
authors.affiliation: Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Ellen
authors.initials: E
authors.lastname: Warner
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000191:economics; D001943:Breast Neoplasms / Q000188:drug therapy*; D002170:Canada; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects / Q000191:economics; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000209:etiology / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D000077143:Docetaxel; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000191:economics / Q000627:therapeutic use*; D006295:Health Resources / Q000191:economics; D006801:Humans; D007902:Length of Stay; D008390:Markov Chains; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000191:economics; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D043823:Taxoids / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D043823:Taxoids; D016179:Granulocyte Colony-Stimulating Factor; D000077143:Docetaxel; D003520:Cyclophosphamide
keywords: adjuvant chemotherapy; breast cancer; cost-effectiveness; febrile neutropenia; primary prophylaxis