Journal Article
. 2008 Aug; 12(2):217-25.
doi: 10.1111/j.1524-4733.2008.00434.x.

Cost-effectiveness of primary versus secondary prophylaxis with pegfilgrastim in women with early-stage breast cancer receiving chemotherapy

Scott D Ramsey 1 Zhimei Liu  Rob Boer  Sean D Sullivan  Jennifer Malin  Quan V Doan  Robert W Dubois  Gary H Lyman  
  • PMID: 18673353
  •     9 citations


Objective: Prophylaxis with granulocyte colony-stimulating factor (G-CSF) reduces the risk of febrile neutropenia (FN) in patients receiving myelosuppressive chemotherapy. We estimated the incremental cost-effectiveness of G-CSF pegfilgrastim primary (starting in cycle 1 and continuing in subsequent cycles of chemotherapy) versus secondary (only after an FN event) prophylaxis in women with early-stage breast cancer receiving myelosuppressive chemotherapy with a >or=20% FN risk.

Methods: A decision-analytic model was constructed from a health insurer's perspective with a lifetime study horizon. The model considers direct medical costs and outcomes related to reduced FN and potential survival benefits because of reduced FN-related mortality. Inputs for the model were obtained from the medical literature. Sensitivity analyses were conducted across plausible ranges in parameter values.

Results: The incremental cost-effectiveness ratio (ICER) of pegfilgrastim as primary versus secondary prophylaxis was $48,000/FN episode avoided. Adding survival benefit from avoiding FN mortality yielded an ICER of $110,000/life-year gained (LYG) or $116,000/quality-adjusted life-year (QALY) gained. The most influential factors included FN case-fatality, FN relative risk reduction from primary prophylaxis, and age at diagnosis.

Conclusions: Compared with secondary prophylaxis, the cost-effectiveness of pegfilgrastim as primary prophylaxis may be equivalent or superior to other commonly used supportive care interventions for women with breast cancer. Further assessment of the direct impact of G-CSF on short- and long-term survival is needed to substantiate these findings.

Advances in the treatment of neutropenia.
David C Dale.
Curr Opin Support Palliat Care, 2009 Jun 25; 3(3). PMID: 19550332    Free PMC article.
Prophylaxis of chemotherapy-induced febrile neutropenia with granulocyte colony-stimulating factors: where are we now?
Matti Aapro, Jeffrey Crawford, Didier Kamioner.
Support Care Cancer, 2010 Mar 02; 18(5). PMID: 20191292    Free PMC article.
Personalized medicine and cancer supportive care: appropriate use of colony-stimulating factor support of chemotherapy.
Nicole M Kuderer, Gary H Lyman.
J Natl Cancer Inst, 2011 Jun 15; 103(12). PMID: 21670422    Free PMC article.
A way forward on the medically appropriate use of white cell growth factors.
Thomas J Smith, Bruce E Hillner.
J Clin Oncol, 2012 Mar 01; 30(14). PMID: 22370327    Free PMC article.
Pharmacoeconomics of the myeloid growth factors: a critical and systematic review.
Bradford R Hirsch, Gary H Lyman.
Pharmacoeconomics, 2012 May 01; 30(6). PMID: 22540394
Systematic Review.
Use and delivery of granulocyte colony-stimulating factor in breast cancer patients receiving neoadjuvant or adjuvant chemotherapy-single-centre experience.
X Zhu, N Bouganim, +3 authors, M J Clemons.
Curr Oncol, 2012 Aug 10; 19(4). PMID: 22876152    Free PMC article.
The value of comparative effectiveness research: projected return on investment of the RxPONDER trial (SWOG S1007).
William B Wong, Scott D Ramsey, +2 authors, David L Veenstra.
Contemp Clin Trials, 2012 Sep 18; 33(6). PMID: 22981891    Free PMC article.
Is febrile neutropenia prophylaxis with granulocyte-colony stimulating factors economically justified for adjuvant TC chemotherapy in breast cancer?
Chris Skedgel, Daniel Rayson, Tallal Younis.
Support Care Cancer, 2015 Jun 18; 24(1). PMID: 26081595
Cost-Utility Analysis of Lipegfilgrastim Compared to Pegfilgrastim for the Prophylaxis of Chemotherapy-Induced Neutropenia in Patients with Stage II-IV Breast Cancer.
Esse I H Akpo, Irshaad R Jansen, Edith Maes, Steven Simoens.
Front Pharmacol, 2017 Sep 29; 8. PMID: 28955224    Free PMC article.