Cost-effectiveness of pegfilgrastim in prostate cancer patients receiving cabazitaxel

Abstract

Abstract Background Cabazitaxel plus predonisolone is used to treat castration-resistant prostate cancer but has a high risk of inducing febrile neutropenia (FN). While pegfilgrastim (Peg-G) is used for prophylaxis of FN, no cost-efficacy analysis has been conducted, despite its substantial expense. The objective this study was to evaluate the cost-effectiveness of Peg-G in patients receiving cabazitaxel. Methods We simulated model patients receiving cabazitaxel and developed a decision-analytical model of patients receiving Peg-G or no prophylaxis (no-G). The costs, probabilities and incremental cost-effectiveness ratio (ICER) of each treatment were calculated from the health insurers’ perspective, and the threshold ICER was set at 6,000,000 JPY per quality-adjusted life-year (QALY). In the base analysis, the cost of Peg-G was set at 106,660 JPY. The probabilities, utility score and other costs were obtained from published sources. The robustness of this model was validated by a one-way sensitivity analysis and probabilistic sensitivity analysis. Results The ICER was calculated to be 9,276,805 JPY per QALY, which was above the threshold. In the one-way sensitivity analysis, if the cost of Peg-G exceeded 97,237 JPY, the ICER fell below the threshold. The probabilistic sensitivity analysis revealed a 50.0% probability that Peg-G was cost-effective compared with no-G. Conclusion Peg-G was not cost-effective compared with no-G. However, if the cost of Peg-G could be reduced below 97,237 JPY, Peg-G would become cost-effective compared with no-G.