Abstract
Background: Pegylated recombinant human granulocyte colony-stimulating factors (PEG-rhG-CSFs) are more commonly and widely used than recombinant human granulocyte colony-stimulating factors (rhG-CSFs) in preventing chemotherapy-induced neutropenia in patients with stage II-IV breast cancer. To reduce the financial burden on these patients, the corresponding medical insurance directory needs to be revised. Objectives: To evaluate the cost-effectiveness of PEG-rhG-CSF versus rhG-CSF in patients with stage II-IV breast cancer in central China. Methods: Two Markov models, a chemotherapy model and a post-chemotherapy model, were developed to study the effects and costs, with a time horizon of 12 weeks and 35 years, respectively. Cost and probability input data were primarily obtained from a retrospective real-world study conducted in five tertiary hospitals. Propensity score matching was adopted to overcome retrospective bias. Other parameters were extracted from literature as well as advice from clinical experts. Univariate and probabilistic sensitivity analyses were conducted. Results: In the first chemotherapy model, PEG-rhG-CSF was associated with fewer episodes of febrile neutropenia (FN) (N = 19 per 1000 patients treated), infections (N = 24 per 1000 patients treated) and deaths (N = 2 per 1000 patients treated), but higher costs (¥36 more per patient treated). The post-chemotherapy model indicated that PEG-rhG-CSF led to higher gains in quality-adjusted life years (QALYs) (11.695 versus 11.516) in comparison to rhG-CSF. Sensitivity analysis showed that the cost of PEG-rhG-CSF had the greatest impact on the incremental costs, and incremental QALYs were very sensitive to the risk of RDI <85%. The probability of PEG-rhG-CSF being cost-effective compared to rhG-CSF was 66% at the willingness to pay (WTP) thresholds of ¥72,371 per QALY gained. Conclusion: According to this economic evaluation based on real-world data, PEG-rhG-CSF may be considered as a more cost-effective strategy relative to rhG-CSF for stage II-IV breast cancer patients in central China. However, to reflect a national perspective, further evidence is needed using data from larger-scale studies.
Highlights
The incidence of breast cancer tops the female cancers in China, and the age standardization incidence rate (ASIR) is increasing every year (World Health Organization, 2020)
A mathematical model was developed in Excel (Microsoft 2016) to estimate the health benefits and costs of using PEG-rhG-CSF compared with rhG-CSF as the primary prophylaxis in two hypothetical cohorts of women with stage II, III, IV breast cancer undergoing chemotherapy
Patient-level real-world data were retrospectively collected from a sample of 926 patients receiving PEG-rhG-CSF and 898 patients receiving rhG-CSF in the selected hospitals
Summary
The incidence of breast cancer tops the female cancers in China, and the age standardization incidence rate (ASIR) is increasing every year (World Health Organization, 2020). In the era of precision medicine, chemotherapy remains the cornerstone of treatment for patients with breast cancer (Chinese Society of Clinical Oncology Guidance Working Committee, 2017), because adjuvant chemotherapy significantly improves disease-free and overall survival, and due to the chemotherapy directly leads to improved patient survival (Esteva et al, 2001; Peto et al, 2012). Accompanying the chemotherapy, neutropenia is a common and frequent side effect, as well as a major risk factor for infection-related morbidity and mortality (Donadieu et al, 2011). The presence of FN in cancer patients may lead to reduced dose intensity (RDI), worsening clinical efficacy, as well as severe infection complications, even death (Chinese Society of Clinical Oncology Guidance Working Committee, 2017). Under the current medical conditions, when the patient’s neutropenia lasts for >21 days, the incidence of infection is significantly increased (Chinese Society of Hematology, 2020). To reduce the financial burden on these patients, the corresponding medical insurance directory needs to be revised
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