Cost-Utility Analysis of Lipegfilgrastim Compared to Pegfilgrastim for the Prophylaxis of Chemotherapy-Induced Neutropenia in Patients with Stage II-IV Breast Cancer

Abstract

Background: Lipegfilgrastim (Lonquex®) has demonstrated to be non-inferior to pegfilgrastim (Neulasta®) in reducing the duration of severe neutropenia (SN) in patients with stage II−IV breast cancer. Compared to pegfilgrastim, lipegfilgrastim also demonstrated statistically significant lower time to ANC recovery in cycles 1–3, lower incidence of SN in cycle 2 and lower depth of absolute neutrophil count (ANC) nadir in cycles 2 and 3. The aim of this study was to quantify the cost utility of lipegfilgrastim compared to pegfilgrastim in stage II−IV breast cancer patients, taking the perspective of the Belgian payer over a lifetime horizon.Methods: Two Markov models were developed to track on- and post-chemotherapy related complications, including SN, febrile neutropenia (FN), chemotherapy dose delay, chemotherapy relative dose intensity of less than 85%, infection, death rates, and quality-adjusted life years (QALYs). Data on costs (2015 value) and effects were obtained from literature, national references, and complemented by a survey of clinical experts using a modified Delphi method. Both deterministic and probabilistic sensitivity analyses were carried out. Outcomes measures included costs, QALYs and life-years (LY).Results: At current equivalent price of €1,169, treatment with lipegfilgrastim was associated with overall costs of €9,845 vs. €10,208 for pegfilgrastim and overall QALYs of 13.977 vs. 13.925 for pegfilgrastim. Life expectancy was increased by 21 days (or 0.058 LY gained). The difference in costs stem from avoided infection, SN and FN cases in the lipegfilgrastim compared to the pegfilgrastim group. Similarly, the difference in QALYs was explained by the difference in the number of patients in the chemotherapy/G-CSF Markov state followed by infection and FN between lipegfilgrastim and pegfilgrastim. The probability of lipegfilgrastim to be cost-effective compared to pegfilgrastim was 68, 79, and 83% at the willingness-to-pay thresholds (WTP) of €10,000, €30,000 and €50,000 per QALY gained, respectively. At a WTP threshold of €30,000 per QALY gained, lipegfilgrastim was cost-effective up to €1,500 across all age bands and cancer stages, compared to the current price.Conclusions: Lipegfilgrastim is a cost-effective use of health care resources in patients with stage II-IV breast cancer.

Cost-Effectiveness Analysis of PEG-rhG-CSF as Primary Prophylaxis to Chemotherapy-Induced Neutropenia in Women With Breast Cancer in China: Results Based on Real-World Data

“…Our analysis demonstrated that PEG-rhG-CSF was more costeffective compared to rhG-CSF as primary prophylaxis under the WTP threshold of one-time GDP per capita. The result was similar to Xia et al ( 2020), but different from Akpo et al (2017), Gao and Li (2018), and Li-Tian et al ( 2019), whose results showed that PEG-rhG-CSF strategy was cost-saving than rhG-CSF. Compared to randomized trials, our study showed that the incidence of FN for the short-acting group was higher than these studies, and the cost of the long-acting group was in excess of approximately ¥2,500, but the price gap in Akpo et al (2017) and Gao and Li (2018) was zero.…”

“…The result was similar to Xia et al ( 2020), but different from Akpo et al (2017), Gao and Li (2018), and Li-Tian et al ( 2019), whose results showed that PEG-rhG-CSF strategy was cost-saving than rhG-CSF. Compared to randomized trials, our study showed that the incidence of FN for the short-acting group was higher than these studies, and the cost of the long-acting group was in excess of approximately ¥2,500, but the price gap in Akpo et al (2017) and Gao and Li (2018) was zero. This may be one of the reasons why their results differed from ours.…”

“…Utility levels for each health state in the chemotherapy and post-chemotherapy models were taken from the published literature ( Tables 1 , 2 ). The estimated utility for the state of chemotherapy, FN/infection, breast cancer survivor during years one to five and after year five was 0.7, 0.33, 0.86, and 0.96 ( Akpo et al, 2017 ). As a result of the lack of data on utility values for infection, these data were assumed to be equal to that of FN, according to Gao and Li (2018) .…”

“…Although several cost-effectiveness analyses evaluating G-CSFs have been published ( Akpo et al, 2017 ; Gao and Li, 2018 ; Li-Tian et al, 2019 ; Xia et al, 2020 ), all of them assumed a cost-effective benefit associated with PEG-rhG-CSFs based on RCTs.…”

Efficacy and safety of lipegfilgrastim versus pegfilgrastim in elderly patients with aggressive B cell non-Hodgkin lymphoma (B-NHL): results of the randomized, open-label, non-inferiority AVOID neutropenia study

“…As a result of its novel pegylation method [ 13 , 14 ], lipegfilgrastim has a different pharmacokinetic and pharmacodynamic profile than pegfilgrastim, specifically higher cumulative exposure and slower clearance, and induces a longer-lasting increase in ANC at equivalent doses [ 15 ]. Analyses utilizing data from patients with breast cancer suggest that lipegfilgrastim is likely to be a cost-effective alternative to pegfilgrastim for primary prohylaxis of complications of chemotherapy-induced neutropenia and associated complications [ 28 , 29 ].…”