PCN196 - The Long-Term Social Value Of Better Targeting G-Csf Therapy To Cancer Patients At Risk Of Febrile Neutropenia

Abstract

Estimate the social value of better targeting granulocyte-colony stimulating factor (G-CSF) to cancer patients with high risk of febrile neutropenia (FN) due to myelosuppressive chemotherapy and patient risk factors. We used The Health Economics Medical Innovation Simulation (THEMIS) microsimulation model to project health economic outcomes for cancer patients. We estimated the lifetime social value of G-CSF therapy for patients with lung, breast, and gynecological cancers, and non-Hodgkin’s lymphoma among a nationally-representative US adult population between 2017 and 2067 under three G-CSF use scenarios: ‘current use’ (24% among high FN-risk, 17% among intermediate FN-risk, and 5% among low FN-risk patients); ‘targeted use’ (100% use among all high FN-risk patients only); ‘reduced use’ (‘current use’ reduced by 20 percentage points in each risk group). Lifetime social value included net discounted treatment costs, savings in healthcare expenditures, monetized patient/caregiver productivity gains and quality-of-life improvements, calculated in 2017 USD. Relative to the current use scenario, targeted use increased the number of treated patients by 115 million, averting 18 million cases of FN during the modeled time period. Targeted use increased treatment costs by $574 billion but generated $937 billion in healthcare expenditures savings, productivity gains, and quality-of-life improvements (assuming $150K/quality-adjusted life year), yielding an overall gain of $364 billion in net social value. Compared to current use, reduced use of G-CSF decreased the total number of treated patients by 9 million, increased FN cases by one million, decreased treatment costs by $44 billion, but also reduced benefits by $62 billion, yielding an overall loss of $18 billion in net social value. Targeting G-CSF treatment to high FN-risk individuals substantially increases the net social value relative to current use. Across-the-board reductions in current use reduce G-CSF spending but, at a net disadvantage to society due to adverse health and economic consequences.