Primary prophylactic colony-stimulating factors for the prevention of chemotherapy-induced febrile neutropenia in breast cancer patients

Renner, Peter; Milazzo, Stefania; Liu, Jianping; Zwahlen, Marcel; Birkmann, Josef; Horneber, Markus

doi:10.1002/14651858.cd007913.pub2

Cited by 63 publications

(58 citation statements)

References 65 publications

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“…Skin toxicity was recorded after each cycle of LD-FRT and chemotherapy, hematological toxicity was evaluated every week. Preventive granulocyte colony-stimulating factors were administered after each chemotherapy cycle, in order to keep the rate of adverse effects caused by neutropenia and infection low [37,38].…”

Section: Methodsmentioning

confidence: 99%

Primary systemic treatment and concomitant low dose radiotherapy for breast cancer: Final results of a prospective phase II study

et al. 2014

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Section: Methodsmentioning

confidence: 99%

Primary systemic treatment and concomitant low dose radiotherapy for breast cancer: Final results of a prospective phase II study

et al. 2014

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“…Risk ratio of FN with G-CSF, relative risk reduction of SN with G-CSF, and relative risk reduction of death from FN with G-CSF were collected from the literature [14][15][16][17]. Probability of severe MSK pain from G-CSF was obtained from a systematic review of CSF use in lymphoma [18].…”

Section: Decision Modelmentioning

confidence: 99%

Cost-effectiveness of prophylactic granulocyte colony-stimulating factor for febrile neutropenia in breast cancer patients receiving FEC-D

Lee

Wong

Trudeau

et al. 2015

Breast Cancer Res Treat

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5-fluorouracil, epirubicin, cyclophosphamide → docetaxel (FEC-D) has been associated with higher-than-expected rates of febrile neutropenia (FN) that meet the current guideline threshold of 20 % for primary prophylaxis (PP) with granulocyte colony-stimulating factor (G-CSF). We examined the cost-effectiveness of FEC-D with varying strategies of G-CSF prophylaxis from the perspective of the public payer in Ontario, Canada. A state-transition model was developed to compare three strategies: FEC-D with secondary prophylaxis (SP) only, PP starting with the first cycle of D, and PP starting with the first cycle of FEC. Analysis was conducted for a hypothetical cohort of 50-year-old early-stage breast cancer patients undergoing adjuvant chemotherapy, at a 10-year horizon. Results were expressed in quality-adjusted life-years (QALYs) and 2013 Canadian dollars. Costs and benefits were discounted at 5 %. Event rates, costs, and utilities were derived from the literature. One-way and probabilistic sensitivity analyses were conducted. Using filgrastim, the incremental cost-effectiveness ratios (ICERs) for starting PP with the first cycle of D and starting PP with the first cycle of FEC, compared to using SP only, were $57,886/QALY and $116,186/QALY, respectively. With pegfilgrastim, the ICERs for the same strategies were $90,735/QALY and $149,483/QALY. Compared to using filgrastim SP only, starting PP with D had a 24 % chance of being cost-effective at a willingness-to-pay (WTP) threshold of $50,000/QALY, and a 99 % chance at a WTP threshold of $100,000/QALY. Results were sensitive to FN-related parameters, such as the risk of FN per cycle with D and the associated mortality, but were robust to uncertainty in parameters related to breast cancer, such as the utilities and hazard of relapse. FEC-D with PP starting with the first cycle of D is most likely to be cost-effective, especially with increased risk of FN and mortality from FN.

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“…Indeed, the potential long-term survival benefit associated with PP G-CSF is not well defined to date, in particular with regard to long-term breast cancer specific survival due to improved chemotherapy delivery. (14,15,16) Clinical practice guidelines should attempt to provide clear consensus statements regarding the survival benefits achieved with PP G-CSF, if any.…”

Section: Discussionmentioning

confidence: 99%

“…(11) PP G-CSF could lead to lower FNmanagement costs and improved patient quality of life due to a reduction in FN event rate, and may also be associated with lower FN-related mortality rates and/or improved long-term cancer survival due to improved chemotherapy delivery. (12,13,14,15,16) PP G-CSF is also associated with significant drug acquisition costs that should be examined within the context of all potential downstream cost savings, quality of life improvements and survival benefits. (17) The adoption of PP G-CSF for FN prevention in various health care jurisdictions could be affected by its value for money (i.e.…”

Section: Introductionmentioning

confidence: 99%

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

Younis

Rayson

Jovanović

et al. 2016

Breast Cancer Res Treat

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Primary prophylactic colony-stimulating factors for the prevention of chemotherapy-induced febrile neutropenia in breast cancer patients

Cited by 63 publications

References 65 publications

Primary systemic treatment and concomitant low dose radiotherapy for breast cancer: Final results of a prospective phase II study

Primary systemic treatment and concomitant low dose radiotherapy for breast cancer: Final results of a prospective phase II study

Cost-effectiveness of prophylactic granulocyte colony-stimulating factor for febrile neutropenia in breast cancer patients receiving FEC-D

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

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