Is febrile neutropenia prophylaxis with granulocyte-colony stimulating factors economically justified for adjuvant TC chemotherapy in breast cancer?

Abstract

Secondary G-CSF is more effective and less costly than a no G-CSF strategy. Primary G-CSF may be justified at higher willingness-to-pay thresholds and/or higher FN risks, but this threshold FN risk appears to be higher than the 20% rate recommended by current clinical guidelines.

Cost-effectiveness of febrile neutropenia prevention with primary versus secondary G-CSF prophylaxis for adjuvant chemotherapy in breast cancer: a systematic review

“…In all other evaluations, (23,24,26,27) PP G-CSF was associated with a less than 50% (range 5 -42%) probability of being a cost-effective strategy when judged against commonly utilized CE thresholds in the various jurisdictions studied. In sensitivity analyses, the value for money of PP G-CSF was primarily dependant on FN mortality rate assumptions, (23,25,26) baseline FN rate, (23,24,25,26) G-CSF costs, (23,24,25,26) and impact of PP on FN rate (23,26) . Conversely, FN utility (23,26) and chemotherapy characteristics, (26) including price and relative effectiveness, appeared to have relatively little impact on G-CSF value for money.…”

“…Conversely, FN utility (23,26) and chemotherapy characteristics, (26) including price and relative effectiveness, appeared to have relatively little impact on G-CSF value for money. Finally, FN management costs (23,25,26) had less significant [DR2]impact on G-CSF cost-effectiveness.…”

“…Five studies met the predefined inclusion / exclusion criteria, and were included in this review (Table 1). (23,24,25,26,27) Backward search did not identify any other eligible studies. The included studies were conducted in different health care jurisdictions (USA = 1, UK = 1, Canada = 3), involved commonly utilized adjuvant taxane-based regimens (TAC = 2; FEC-D = 1; TC = 2), and all reported on incremental costs per QALY gained, albeit at different time horizons (range: 3-month to lifetime).…”

“…In sensitivity analyses, the value for money of PP G-CSF was primarily dependant on FN mortality rate assumptions, (23,25,26) baseline FN rate, (23,24,25,26) G-CSF costs, (23,24,25,26) and impact of PP on FN rate (23,26) . Conversely, FN utility (23,26) and chemotherapy characteristics, (26) including price and relative effectiveness, appeared to have relatively little impact on G-CSF value for money. Finally, FN management costs (23,25,26) had less significant [DR2]impact on G-CSF cost-effectiveness.…”

“…In one Canadian study, (26) PP G-CSF with filgrastim would meet a $100,000/QALY gained threshold at a FN rate > 28% assuming some loss of chemotherapy efficacy at lower chemotherapy doses, and at a > 22% rate assuming further loss of chemotherapy efficacy with every FN event regardless of subsequent chemotherapy doses. In the UK study, (24) PP G-CSF with pegfilgrastim would meet a £30,000/QALY gained threshold at a FN rate greater than 29%.…”