Pegfilgrastim for the prevention of febrile neutropenia in patients with epithelial ovarian carcinoma—a cost-effectiveness analysis

Abstract

The objective is to assess the cost-effectiveness of pegfilgrastim for the prevention of hospitalization due to febrile neutropenia (FN) in patients with epithelial ovarian carcinoma (EOC) receiving taxane/platinum-based chemotherapy. A decision analysis model evaluated a hypothetical cohort of 10,000 patients receiving six cycles of taxane/platinum-based chemotherapy for EOC. Three strategies were analyzed for the prevention of hospitalization due to FN: 1) dose modifications and delays after a hospitalization for FN without the use of granulocyte-colony stimulating factors (G-CSF) (NO G-CSF); 2) all patients receive G-CSF with each chemotherapy cycle (1 degrees PROPHYLAXIS); 3) patients receive G-CSF for all subsequent chemotherapy cycles after a hospitalization for FN (2 degrees PROPHYLAXIS). The model was applied to two patient populations: 1) an average-risk population (FN hospitalization rate = 5%); 2) a high-risk population (FN hospitalization rate = 16%). Using baseline assumptions in an average-risk population, NO G-CSF was the least expensive strategy with a cost of $68 million and resulted in 2,860 hospitalizations for FN. 2 degrees PROPHYLAXIS resulted in 141 fewer hospitalizations than NO G-CSF at a cost of $76,288 per hospitalization prevented. 1 degrees PROPHYLAXIS was the most effective and resulted in 1,689 fewer hospitalizations for FN compared to NO G-CSF at a cost of $47,343 per hospitalization prevented. When this model is applied to a high-risk patient population, 1 degrees PROPHYLAXIS is more effective and less expensive than both NO G-CSF and 2 degrees PROPHYLAXIS. We conclude that in average-risk patients receiving chemotherapy for EOC the use of pegfilgrastim is effective at reducing hospitalizations due to FN, but at a significant cost. However, in high-risk patients, primary prophylaxis is the only cost-effective strategy and should be strongly considered.

Myeloid Growth Factors, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology

“…25 Economic analyses of MGFs have yielded mixed results, depending on the context of use. [119][120][121][122][123] Although the addition of MGFs to treatment regimens inevitably increases the drug cost, it may actually equate to substantial savings compared with the cost of hospitalization and subsequent treatment of neutropenia.…”

Prophylaxis of febrile neutropenia with colony-stimulating factors: the first 25 years

“…In adult patients with solid tumors and non-myeloid malignancies, primary prophylaxis with CSFs is recommended if overall risk of FN is high (>20%) and is to be considered for patients at intermediate risk of pegfilgrastim for the prevention of FN in patients with ovarian cancer receiving chemotherapy conferring a risk of FN of either 5% ("average risk") or 16% ("high risk") 51 . Three strategies were compared: (1) dose delays or modification only after FN; (2) primary prevention; and (3) secondary prevention.…”

Myeloid Growth Factors

“…25 Economic analyses of CSFs have yielded mixed results, depending on the context of use. [26][27][28][29][30] However, the policy of the panel is to primarily examine issues of therapeutic efficacy and clinical benefit, rather than cost. The indication for prophylactic CSF use depends on the risk of FN or other neutropenic events that can potentially compromise treatment.…”