title: Cost-Effectiveness Analysis of Prophylaxis Treatment Strategies to Reduce the Incidence of Febrile Neutropenia in Patients with Early-Stage Breast Cancer or Non-Hodgkin Lymphoma.
abstract: OBJECTIVE
  The objective of this study was to evaluate the cost effectiveness of no prophylaxis, primary prophylaxis (PP), or secondary prophylaxis (SP) with granulocyte colony-stimulating factors (G-CSFs), i.e., pegfilgrastim, lipegfilgrastim, filgrastim (6- and 11-day), or lenograstim (6- and 11-day), to reduce the incidence of febrile neutropenia (FN) in patients with stage II breast cancer receiving TC (docetaxel, cyclophosphamide) and in patients with non-Hodgkin lymphoma (NHL) receiving R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) over a lifetime horizon from a Belgian payer perspective.
  
  
  METHODS
  A Markov cycle tree tracked FN events during chemotherapy (3-week cycles) and long-term survival (1-year cycles). Model inputs, including the efficacy of each strategy, risk of reduced relative dose intensity (RDI), and the impact of RDI on mortality, utilities, and costs (in €; 2014 values) were estimated from public sources and the published literature. Incremental cost-effectiveness ratios (ICERs) were assessed for each strategy for costs per FN event avoided, life-year (LY) saved, and quality-adjusted LY (QALY) saved. LYs and QALYs saved were discounted at 1.5% annually. Deterministic and probabilistic sensitivity analyses (DSAs and PSAs) were conducted.
  
  
  RESULTS
  Base-case ICERs for PP with pegfilgrastim relative to SP with pegfilgrastim were €15,500 per QALY and €14,800 per LY saved for stage II breast cancer and €7800 per QALY and €6900 per LY saved for NHL; other comparators were either more expensive and less effective than PP or SP with pegfilgrastim or had lower costs but higher ICERs (relative to SP with pegfilgrastim) than PP with pegfilgrastim. Results of the DSA for breast cancer and NHL comparing PP and SP with pegfilgrastim indicate that the model results were most sensitive to the cycle 1 risk of FN, the proportion of FN events requiring hospitalization, the relative risk of FN in cycles ≥2 versus cycle 1, no history of FN, and the mortality hazard ratio for RDI (<90% vs ≥90% [for NHL]). In the PSAs for stage II breast cancer and NHL, the probabilities that PP with pegfilgrastim was cost effective or dominant versus all other prophylaxis strategies at a €30,000/QALY willingness-to-pay threshold were 52% (other strategies ≤24%) and 58% (other strategies ≤24%), respectively.
  
  
  CONCLUSIONS
  From a Belgian payer perspective, PP with pegfilgrastim appears cost effective compared to other prophylaxis strategies in patients with stage II breast cancer or NHL at a €30,000/QALY threshold.
authors.affiliation: Optum, 950 Winter St, Waltham, MA, 02451, USA. kelly.fust@optum.com.
authors.forename: Kelly
authors.initials: K
authors.lastname: Fust
authors.affiliation: Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA, 91320, USA.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Li
authors.affiliation: Optum, 5500 North Service Road, Suite 501, Burlington, ON, L7L 6W6, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Maschio
authors.affiliation: Amgen (Europe) GmbH, Dammstrasse 23, Zug, Switzerland.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Villa
authors.affiliation: Optum, 950 Winter St, Waltham, MA, 02451, USA.
authors.forename: Anju
authors.initials: A
authors.lastname: Parthan
authors.affiliation: Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA, 91320, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Barron
authors.affiliation: Harvard T.H. Chan School of Public Health, 718 Huntington Avenue, Boston, MA, 02115, USA.
authors.forename: Milton C
authors.initials: MC
authors.lastname: Weinstein
authors.affiliation: OncoLogX bvba, Arthur Boelstraat 66, 2990, Wuustwezel, Antwerp, Belgium.
authors.forename: Luc
authors.initials: L
authors.lastname: Somers
authors.affiliation: Amgen Belgium S.A., Avenue Ariane 5, 1200, Brussels, Belgium.
authors.forename: Caroline
authors.initials: C
authors.lastname: Hoefkens
authors.affiliation: Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., Seattle, WA, 98109, USA.
authors.forename: Gary H
authors.initials: GH
authors.lastname: Lyman
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects* / Q000191:economics; D001530:Belgium; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology; D003362:Cost-Benefit Analysis; D064147:Febrile Neutropenia / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage* / Q000191:economics; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy / Q000473:pathology; D008297:Male; D008390:Markov Chains; D009367:Neoplasm Staging; D019057:Quality-Adjusted Life Years; D015996:Survival Rate
chemical_list: D016179:Granulocyte Colony-Stimulating Factor