Journal Article
. 2011 Jun; 14(4):465-74.
doi: 10.1016/j.jval.2010.10.037.

Cost-effectiveness of granulocyte colony-stimulating factor prophylaxis for febrile neutropenia in breast cancer in the United Kingdom

Sophie Whyte 1 Katy L Cooper  Matt D Stevenson  Jason Madan  Ron Akehurst  
  • PMID: 21669371
  •     12 citations


Objective: We report a cost-effectiveness evaluation of granulocyte colony-stimulating factors (G-CSFs) for the prevention of febrile neutropenia (FN) after chemotherapy in the United Kingdom (UK).

Methods: A mathematical model was constructed simulating the experience of women with breast cancer undergoing chemotherapy. Three strategies were modeled: primary prophylaxis (G-CSFs administered in all cycles), secondary prophylaxis (G-CSFs administered in all cycles after an FN event), and no G-CSF prophylaxis. Three G-CSFs were considered: filgrastim, lenograstim, and pegfilgrastim. Costs were taken from UK databases and utility values from published sources. A systematic review provided data on G-CSF efficacy. Probabilistic sensitivity analyses examined the effects of uncertainty in model parameters.

Results: In the UK, base-case analysis with a willingness-to-pay (WTP) threshold of £20K per quality-adjusted life year gained and also using list prices, the most cost-effective strategy was primary prophylaxis with pegfilgrastim for a patient with baseline FN risk greater than 38%, secondary prophylaxis with pegfilgrastim for baseline FN risk 11% to 37%, and no G-CSFs for baseline FN risk less than 11%. Using a WTP threshold of £30K and list prices, primary prophylaxis with pegfilgrastim was cost-effective for baseline FN risks greater than 29%. In all analyses, pegfilgrastim dominated filgrastim and lenograstim. Sensitivity analyses demonstrated that higher WTP threshold, younger age, earlier stage at diagnosis, or reduced G-CSF prices result in G-CSF prophylaxis being cost-effective at lower baseline FN risk levels.

Conclusion: Pegfilgrastim was the most cost-effective G-CSF. The most cost-effective strategy (primary or secondary prophylaxis) was dependent on the FN risk level for an individual patient, patient age and stage at diagnosis, and G-CSF price.

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.
Cost-effectiveness analysis of breast cancer control interventions in Peru.
Sten G Zelle, Tatiana Vidaurre, +8 authors, Rob Baltussen.
PLoS One, 2013 Dec 19; 8(12). PMID: 24349314    Free PMC article.
Cost-effectiveness of breast cancer control strategies in Central America: the cases of Costa Rica and Mexico.
Laurens M Niëns, Sten G Zelle, +4 authors, Frans F H Rutten.
PLoS One, 2014 Apr 29; 9(4). PMID: 24769920    Free PMC article.
Model-based approach to early predict prolonged high grade neutropenia in carboplatin-treated patients and guide G-CSF prophylactic treatment.
Mélanie L Pastor, Céline M Laffont, +2 authors, Didier Concordet.
Pharm Res, 2014 Sep 05; 32(2). PMID: 25186439
Cost-effectiveness analysis of prognostic gene expression signature-based stratification of early breast cancer patients.
Patricia R Blank, Martin Filipits, +11 authors, Michael Gnant.
Pharmacoeconomics, 2014 Nov 19; 33(2). PMID: 25404424    Free PMC article.
Clinical practice in febrile neutropenia risk assessment and granulocyte colony-stimulating factor primary prophylaxis of febrile neutropenia in Poland.
Marek Wojtukiewicz, Ewa Chmielowska, +5 authors, Elżbieta Kosno-Kruszewska.
Contemp Oncol (Pozn), 2014 Jan 01; 18(6). PMID: 25784841    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-Effectiveness Analysis of Prophylaxis Treatment Strategies to Reduce the Incidence of Febrile Neutropenia in Patients with Early-Stage Breast Cancer or Non-Hodgkin Lymphoma.
Kelly Fust, Xiaoyan Li, +7 authors, Gary H Lyman.
Pharmacoeconomics, 2016 Dec 09; 35(4). PMID: 27928760    Free PMC article.
Optimizing Symptoms and Management of Febrile Neutropenia among Cancer Patients: Current Status and Future Directions.
Xiao Jun Wang, Alexandre Chan.
Curr Oncol Rep, 2017 Mar 09; 19(3). PMID: 28271398
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.
Transient co-expression with three O-glycosylation enzymes allows production of GalNAc-O-glycosylated Granulocyte-Colony Stimulating Factor in N. benthamiana.
Israel A Ramírez-Alanis, Justin B Renaud, +2 authors, Guy A Cardineau.
Plant Methods, 2018 Nov 10; 14. PMID: 30410568    Free PMC article.
Ex vivo Manufactured Neutrophils for Treatment of Neutropenia-A Process Economic Evaluation.
Mario A Torres-Acosta, Richard P Harrison, +2 authors, Marion E G Brunck.
Front Med (Lausanne), 2019 Mar 19; 6. PMID: 30881955    Free PMC article.