title: Cost-effectiveness of febrile neutropenia prevention with primary versus secondary G-CSF prophylaxis for adjuvant chemotherapy in breast cancer: a systematic review.
abstract: The adoption of primary (PP) versus secondary prophylaxis (SP) of febrile neutropenia (FN), with granulocyte colony-stimulating factors (G-CSF), for adjuvant chemotherapy (AC) regimens in breast cancer (BC) could be affected by its "value for money". This systematic review examined (i) cost-effectiveness of PP versus SP, (ii) FN threshold at which PP is cost-effective including the guidelines 20 % threshold and (iii) potential impact of G-CSF efficacy assumptions on outcomes. The systematic review identified all cost-effectiveness/cost-utility analyses (CEA/CUA) involving PP versus SP G-CSF for AC in BC that met predefined inclusion/exclusion criteria. Five relevant CEA/CUA were identified. These CEA/CUA examined different AC regimens (TAC = 2; FEC-D = 1; TC = 2) and G-CSF formulations (filgrastim "F" = 4; pegfilgrastim "P" = 4) with varying baseline FN-risk (range 22-32 %), mortality (range 1.4-6.0 %) and utility (range 0.33-0.47). The potential G-CSF benefit, including FN risk reduction with P versus F, varied among models. Overall, relative to SP, PP was not associated with good value for money, as per commonly utilized CE thresholds, at the baseline FN rates examined, including the consensus 20 % FN threshold, in most of these studies. The value for money associated with PP versus SP was primarily dependent on G-CSF benefit assumptions including reduced FN mortality and improved BC survival. PP G-CSF for FN prevention in BC patients undergoing AC may not be a cost-effective strategy at the guidelines 20 % FN threshold.
authors: Department of Medicine at Dalhousie University and the Atlantic Clinical Cancer Research Unit (ACCRU) at the Queen Elizabeth II Health Sciences Centre, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada. tallal.younis@nshealth.ca.
authors: T
authors: T
authors: Younis
authors: Department of Medicine at Dalhousie University and the Atlantic Clinical Cancer Research Unit (ACCRU) at the Queen Elizabeth II Health Sciences Centre, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada.
authors: D
authors: D
authors: Rayson
authors: Department of Medicine at Dalhousie University and the Atlantic Clinical Cancer Research Unit (ACCRU) at the Queen Elizabeth II Health Sciences Centre, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada.
authors: S
authors: S
authors: Jovanovic
authors: Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK.
authors: C
authors: C
authors: Skedgel
mesh_terms: D001943:Breast Neoplasms / Q000188:drug therapy; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D003362:Cost-Benefit Analysis; D064147:Febrile Neutropenia / Q000139:chemically induced / Q000191:economics / Q000517:prevention & control*; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D011322:Primary Prevention / Q000191:economics*; D019057:Quality-Adjusted Life Years; D055502:Secondary Prevention / Q000191:economics*; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D016179:Granulocyte Colony-Stimulating Factor
keywords: Breast cancer; Cost-effectiveness; Febrile neutropenia; G-CSF prophylaxis; Value for money