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Cost-effectiveness of granulocyte colony–stimulating factor prophylaxis for febrile neutropenia in breast cancer in the United Kingdom
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Whyte, Sophie, Cooper, Katy L., Stevenson, Matt D., Madan, Jason and Akehurst, Ron (2011) Cost-effectiveness of granulocyte colony–stimulating factor prophylaxis for febrile neutropenia in breast cancer in the United Kingdom. Value in Health, Vol.14 (No.4). pp. 465-474. doi:10.1016/j.jval.2010.10.037
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Official URL: http://dx.doi.org/10.1016/j.jval.2010.10.037
Abstract
OBJECTIVE:
We report a cost-effectiveness evaluation of granulocyte colony-stimulating factors (G-CSFs) for the prevention of febrile neutropenia (FN) after chemotherapy in the United Kingdom (UK).
METHODS:
A mathematical model was constructed simulating the experience of women with breast cancer undergoing chemotherapy. Three strategies were modeled: primary prophylaxis (G-CSFs administered in all cycles), secondary prophylaxis (G-CSFs administered in all cycles after an FN event), and no G-CSF prophylaxis. Three G-CSFs were considered: filgrastim, lenograstim, and pegfilgrastim. Costs were taken from UK databases and utility values from published sources. A systematic review provided data on G-CSF efficacy. Probabilistic sensitivity analyses examined the effects of uncertainty in model parameters.
RESULTS:
In the UK, base-case analysis with a willingness-to-pay (WTP) threshold of £20K per quality-adjusted life year gained and also using list prices, the most cost-effective strategy was primary prophylaxis with pegfilgrastim for a patient with baseline FN risk greater than 38%, secondary prophylaxis with pegfilgrastim for baseline FN risk 11% to 37%, and no G-CSFs for baseline FN risk less than 11%. Using a WTP threshold of £30K and list prices, primary prophylaxis with pegfilgrastim was cost-effective for baseline FN risks greater than 29%. In all analyses, pegfilgrastim dominated filgrastim and lenograstim. Sensitivity analyses demonstrated that higher WTP threshold, younger age, earlier stage at diagnosis, or reduced G-CSF prices result in G-CSF prophylaxis being cost-effective at lower baseline FN risk levels.
CONCLUSION:
Pegfilgrastim was the most cost-effective G-CSF. The most cost-effective strategy (primary or secondary prophylaxis) was dependent on the FN risk level for an individual patient, patient age and stage at diagnosis, and G-CSF price.
| Item Type: | Journal Article | ||||
|---|---|---|---|---|---|
| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School |
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| Journal or Publication Title: | Value in Health | ||||
| Publisher: | Wiley-Blackwell Publishing, Inc | ||||
| ISSN: | 1098-3015 | ||||
| Official Date: | 2011 | ||||
| Dates: |
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| Volume: | Vol.14 | ||||
| Number: | No.4 | ||||
| Page Range: | pp. 465-474 | ||||
| DOI: | 10.1016/j.jval.2010.10.037 | ||||
| Status: | Peer Reviewed | ||||
| Publication Status: | Published | ||||
| Access rights to Published version: | Restricted or Subscription Access |
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