Is it reasonable to administer pegfilgrastim on day 1 of a myelosuppressive chemotherapy regimen? A cost-utility analysis.

Abstract

BACKGROUND:

There is recent evidence supporting the safety and efficacy of same-day dosing of pegfilgrastim in patients undergoing chemotherapy.

OBJECTIVE:

To determine the cost-effectiveness of pegfilgrastim on day 1 (D1) versus day 2 (D2) for primary prevention of neutropenia in women receiving chemotherapy.

MATERIALS AND METHODS:

A cost-utility model was designed comparing standard D2 versus D1 administration of pegfilgrastim to ovarian cancer patients receiving chemotherapy with an intermediate risk (10-15%) of febrile neutropenia (FN). Rates of FN despite prophylaxis were modeled as 10% for D1 and 5% for D2. Societal costs associated with D2 injection ($175.71) were incorporated. Quality of life (QOL) was modeled from published data; we assumed a small decrement in QOL on treatment days. Sensitivity analyses were performed.

RESULTS:

D1 administration was less costly ($17,195 versus $17,681) and resulted in higher QOL (0.2298 quality adjusted life years (QALYs) versus 0.2288 QALYs) than D2. Results were sensitive to the risk of FN. D1 remained dominant or cost-effective (ICER less than $50,000/QALY) compared to D2 if the FN rate with D1 was assumed less than 14.5% (baseline estimate 10%). If the FN rate with D1 was assumed greater than or equal to 15%, D1 was not cost-effective compared to D2, with an ICER greater than $100,000/QALY. Findings are insensitive to variations in the modeled cost of treating FN, the additional cost of D2 injection, and the reduced QOL associated with treatment visits.

CONCLUSION:

Administration of D1 pegfilgrastim is cost-effective in women with ovarian cancer who are treated with intermediate risk chemotherapy.

• Authors: Caroline C Billingsley, David E Cohn, Aleia K Crim, Quan Li, David M O'Malley, Laura J Havrilesky
• Journal: Cancer treatment and research communications (Cancer Treat Res Commun) Vol. 14 Pg. 21-25 ( 2018) ISSN: 2468-2942 [Electronic] England
• PMID: 30104004 (Publication Type: Journal Article)
• Copyright: Copyright © 2017. Published by Elsevier Ltd.

Chemical References

• Antineoplastic Agents
• pegfilgrastim
• Polyethylene Glycols
• Filgrastim

Topics

• Antineoplastic Agents (therapeutic use)
• Cost-Benefit Analysis
• Drug Administration Schedule
• Febrile Neutropenia (chemically induced, drug therapy, prevention & control)
• Female
• Filgrastim (administration & dosage, economics)
• Humans
• Ovarian Neoplasms (drug therapy)
• Polyethylene Glycols (administration & dosage, economics)
• Primary Prevention
• Quality of Life
• Quality-Adjusted Life Years
• Risk Factors