title: Routine Primary Prophylaxis for Febrile Neutropenia with Biosimilar Granulocyte Colony-Stimulating Factor (Nivestim) or Pegfilgrastim Is Cost Effective in Non-Hodgkin Lymphoma Patients undergoing Curative-Intent R-CHOP Chemotherapy.
abstract: OBJECTIVE
  This study aims to compare the cost-effectiveness of various strategies of myeloid growth factor prophylaxis for reducing the risk of febrile neutropenia (FN) in patients with non-Hodgkin lymphoma in Singapore who are undergoing R-CHOP chemotherapy with curative intent.
  
  
  METHODS
  A Markov model was created to compare seven prophylaxis strategies: 1) primary prophylaxis (PP) with nivestim (biosimilar filgrastim) throughout all cycles of chemotherapy; 2) PP with nivestim during the first two cycles of chemotherapy; 3) secondary prophylaxis (SP) with nivestim; 4) PP with pegfilgrastim throughout all cycles of chemotherapy; 5) PP with pegfilgrastim during the first two cycles of chemotherapy; 6) SP with pegfilgrastim; and 7) no prophylaxis (NP). The perspective of a hospital was taken and cost-effectiveness was expressed as the cost per episode of FN avoided over six cycles of chemotherapy. A probabilistic sensitivity analysis was conducted.
  
  
  RESULTS
  Strategies 3, 6, and 7 were dominated in the base case analysis by strategy 5. The costs associated with strategies 2, 5, 1, and 4 were US$3,813, US$4,056, US$4,545, and US$5,331, respectively. The incremental cost-effectiveness ratios for strategy 5 vs. strategy 2, strategy 1 vs. strategy 5, and strategy 4 vs. strategy 1 were US$13,532, US$22,565, and US$30,452, respectively, per episode of FN avoided. Strategy 2 has the highest probability to be cost-effective (ranged from 48% to 60%) when the willingness to pay (WTP) threshold is lower than US$10,000 per FN episode prevented.
  
  
  CONCLUSIONS
  In Singapore, routine PP with granulocyte colony-stimulating factor (nivestim or pegfilgrastim) is cost-effective for reducing the risk of FN in patients receiving R-CHOP.
authors.affiliation: Department of Pharmacy, National University of Singapore, Singapore, Singapore.|Department of Pharmacy, National Cancer Centre Singapore, Singapore, Singapore.
authors.forename: Xiao Jun
authors.initials: XJ
authors.lastname: Wang
authors.affiliation: Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Tang
authors.affiliation: Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Farid
authors.affiliation: Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.
authors.forename: Richard
authors.initials: R
authors.lastname: Quek
authors.affiliation: Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.
authors.forename: Miriam
authors.initials: M
authors.lastname: Tao
authors.affiliation: Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.
authors.forename: Soon Thye
authors.initials: ST
authors.lastname: Lim
authors.affiliation: Department of Pharmacy, National University of Singapore, Singapore, Singapore.
authors.forename: Hwee Lin
authors.initials: HL
authors.lastname: Wee
authors.affiliation: Department of Pharmacy, National University of Singapore, Singapore, Singapore.|Department of Pharmacy, National Cancer Centre Singapore, Singapore, Singapore.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Chan
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000191:economics / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics / Q000627:therapeutic use*; D059451:Biosimilar Pharmaceuticals / Q000191:economics / Q000627:therapeutic use*; D018890:Chemoprevention / Q000191:economics; D003362:Cost-Benefit Analysis; D003520:Cyclophosphamide / Q000191:economics / Q000627:therapeutic use; D004317:Doxorubicin / Q000191:economics / Q000627:therapeutic use; D064147:Febrile Neutropenia / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control*; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000150:complications* / Q000188:drug therapy* / Q000191:economics; D008390:Markov Chains; D011092:Polyethylene Glycols; D011241:Prednisone / Q000191:economics / Q000627:therapeutic use; D011336:Probability; D011994:Recombinant Proteins / Q000191:economics / Q000627:therapeutic use; D000069283:Rituximab; D012846:Singapore / Q000453:epidemiology; D014750:Vincristine / Q000191:economics / Q000627:therapeutic use
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D059451:Biosimilar Pharmaceuticals; C571759:R-CHOP protocol; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; C455861:pegfilgrastim; D011092:Polyethylene Glycols; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D000069585:Filgrastim; D011241:Prednisone