Abstract
Purpose: The aim of the study was to evaluate the cost-effectiveness of PEGylated recombinant human granulocyte–stimulating factor (PEG-rhG-CSF) as a means of achieving primary and secondary prophylaxis against chemotherapy-induced neutropenia cancer cases. Methods: Individuals who underwent PEG-rhG-CSF therapeutics were monitored for 12 months, together with thorough examination of individual medical records for extracting medical care costs. Both prophylaxis-based therapeutic options (primary/secondary) were scrutinized for cost-effectiveness, using a decision-making analysis model which derived the perspective of Chinese payers. One-way and probabilistic sensitivity analyses were used to assess the robustness of the model. Results: In summary, 130 clinical cases treated using PEG-rhG-CSF prophylaxis were included in this study: 51 within the primary prophylaxis (PP) group and 79 within the secondary prophylaxis (SP) group. Compared with SP, PP-based PEG-rhG-CSF successfully contributed to a 14.3% reduction in febrile neutropenia. In general, PP was estimated to reduce costs by $4,701.81 in comparison to SP, with a gain of 0.02 quality-adjusted life years (QALYs). Equivalent results were found in differing febrile neutropenia (FN) risk subgroups. Sensitivity analyses found the model outputs to be most affected for the average time of hospitalization and for the cost of FN. Conclusion: From the perspective of Chinese payers, PP with PEG-rhG-CSF should be considered cost-effective compared to SP strategies in patients who received chemotherapy regimens with a middle- to high-risk of FN.
Highlights
Chemotherapy-induced febrile neutropenia (FN) is a main repercussion derived from myelosuppression stemming from chemotherapeutic measures (Aarts et al, 2013)
The criteria for including patients into this study were as follows: a) adult age (18–75 years); b) malignancy diagnosed by pathological histology or cytology; c) receiving chemotherapy with medium- to high-risk FN regimen; and d) having received PEG-recombinant human granulocyte colony–stimulating factor (rhG-CSF) as primary or secondary prophylaxis during chemotherapy
For all patients in this study, PEG-rhGCSF as primary prophylaxis dominated all comparators on FN events avoided and QALYs gained
Summary
Chemotherapy-induced febrile neutropenia (FN) is a main repercussion derived from myelosuppression stemming from chemotherapeutic measures (Aarts et al, 2013). FN can lead to lowering dose limits of chemotherapy drugs, delayed chemotherapy, and severe infections. Such repercussions typically increase treatment costs, together with reducing the efficacy of chemotherapy and quality of survival, affecting patient prognosis and possibly even leading to death (Gisselbrecht et al., 1997; Tirelli et al, 1998). Primary/secondary prophylaxis measures employing granulocyte colony–stimulating factor (G-CSF) were recommended by national and international guidelines as a measure for reducing FN development within the most vulnerable patients incurring elevated risks of FN (Aapro et al, 2010; Langford and Chrisp, 2010; Smith et al, 2015). Prophylaxis protocols that rely solely on the type and intensity of chemotherapy regimens can result in exposing patients to a greater number of FN events
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