title: Cost-effectiveness of granulocyte colony-stimulating factor prophylaxis in chemotherapy-induced febrile neutropenia among breast cancer and Non-Hodgkin's lymphoma patients under Taiwan's national health insurance system.
abstract: OBJECTIVE
  The beneficial effects of granulocyte colony-stimulating factor (G-CSF) prophylaxis on reducing the risk of chemotherapy-induced febrile neutropenia (CIFN) were well documented throughout the literature. However, existing data regarding its cost-effectiveness were conflicting. We estimated the cost-effectiveness of G-CSF prophylaxis in CIFN under Taiwan's National Health Insurance (NHI) system.
  
  
  METHODS
  Data on clinical outcomes and direct medical costs were derived for 5179 newly diagnosed breast cancer and 629 non-Hodgkin's lymphoma (NHL) patients from the NHI claims database. Patients were further categorized into three subgroups as "primary-", "secondary-" and "no -" prophylaxis based on their patterns of G-CSF use. Generalized estimating equations were applied to estimate the impact of G-CSF use on the incidence of CIFN. The incremental cost-effectiveness ratios of primary and secondary prophylactic G-CSF use were calculated and sensitivity analyses were performed.
  
  
  RESULTS
  Primary prophylaxis of G-CSF decreased the incidence of CIFN by 27% and 83%, while secondary prophylaxis by 34% and 22% in breast cancer and NHL patients, respectively. Compared with those with no prophylaxis, the incremental cost per CIFN reduced in primary prophylaxis is $931 and $52 among patients with breast cancer and NHL, respectively. In contrast, secondary prophylaxis is dominated by no prophylaxis and primary prophylaxis in both cancer patients.
  
  
  CONCLUSIONS
  Primary but not secondary prophylactic use of G-CSF was cost-effective in CIFN in breast cancer and NHL patients under Taiwan's NHI system.
authors.affiliation: Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Tsun-Jen
authors.initials: TJ
authors.lastname: Wen
authors.affiliation: Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Tao-Yuan, Taiwan.
authors.forename: Yu-Wen
authors.initials: YW
authors.lastname: Wen
authors.affiliation: Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan.|School of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Chun-Ru
authors.initials: CR
authors.lastname: Chien
authors.affiliation: Department of Pharmacy, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
authors.forename: Shao-Chin
authors.initials: SC
authors.lastname: Chiang
authors.affiliation: Department of Computer Science and Engineering, National Taiwan Ocean University, Keelung, Taiwan.
authors.forename: William Wei-Yuan
authors.initials: WW
authors.lastname: Hsu
authors.affiliation: Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.|School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.|Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Li-Jiuan
authors.initials: LJ
authors.lastname: Shen
authors.affiliation: Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.|School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.|Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Fei-Yuan
authors.initials: FY
authors.lastname: Hsiao
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects; D001943:Breast Neoplasms / Q000188:drug therapy; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage* / Q000191:economics*; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics; D065129:Pre-Exposure Prophylaxis / Q000191:economics*; D011322:Primary Prevention / Q000191:economics; D012189:Retrospective Studies; D055502:Secondary Prevention / Q000191:economics; D013624:Taiwan
chemical_list: D000970:Antineoplastic Agents; D016179:Granulocyte Colony-Stimulating Factor
keywords: National Health Insurance Research Database (NHIRD); breast cancer; chemotherapy-induced febrile neutropenia (CIFN); cost-effectiveness; granulocyte colony-stimulating factor (G-CSF); non-Hodgkin's lymphoma (NHL)