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Cost-effectiveness analysis of febrile neutropenia (FN) prophylaxis with pegfilgrastim in non-Hodgkin's lymphoma (NHL) patients treated with chemotherapy in Spain
  1. A. Dominguez-Gil,
  2. A. Alegre,
  3. A. Lopez,
  4. I. Oyagüez,
  5. L. Gutierrez,
  6. G. Restovic,
  7. M.A. Casado
  1. 1Hospital Universitario de Salamanca, Pharmacy Department, Salamanca, Spain
  2. 2Hospital La Princesa, Hematology Department, Madrid, Spain
  3. 3Hospital Valle Hebrón, Hematology Department, Barcelona, Spain
  4. 4Pharmacoeconomics and Outcomes Research Iberia, Consultant, Madrid, Spain
  5. 5Amgen, Health Economics Department, Barcelona, Spain
  6. 6Pharmacoeconomics and Outcomes Research Iberia, Health Economics Department, Madrid, Spain

Abstract

Background Granulocyte-colony stimulating factor (G-CSF) prophylaxis reduces the risk of FN in NHL patients receiving myelosuppressive chemotherapy.

View this table:
Table 1

Costs and QALYs gained by strategy

Purpose To estimate incremental cost-effectiveness ratios (ICERs) of pegfilgrastim prophylaxis versus other prophylaxis strategies in NHL patients from the perspective of the Spanish NHS.

Materials and methods A Markov model simulated lifetime effectiveness (quality adjusted life years-QALYs) and cost (€2011) in NHL patients receiving CHOP21±R. Pegfilgrastim was compared with 11-day filgrastim (Neupogen), 6-day filgrastim, and no prophylaxis (no use of G-CSF); these strategies were compared within primary (PP) and secondary (SP) prophylaxis. Model inputs were: risk of FN, mortality, probability of relative dose intensity RDI<85%, relative FN-risk of strategies, and utilities. The annual discount rate for cost and outcomes was 3%.

Results Effectiveness analyses (QALYs) demonstrated pegfilgrastim-PP was the most effective treatment. Assuming an accepted threshold of €30,000/QALY, PP with pegfilgrastim versus other PP strategies was cost-effective for CHOP21 (ICER of pegfilgrastim vs 11-day filgrastim, 6-day filgrastim or no prophylaxis of €3,606, €8,383 and €14,881 per QALY, respectively) and CHOP21-R (ICER of pegfilgrastim vs 11-day filgrastim, 6-day filgrastim or no prophylaxis of €5,895, €11,433 and €18,898 per QALY, respectively). Similarly, SP with pegfilgrastim versus other SP strategies was cost-effective, being the dominant SP strategy (more effective and less costly) versus 11- and 6-day filgrastim for CHOP21 and 11-day filgrastim for CHOP21-R. Compared to no prophylaxis, pegfilgrastim-SP had an ICER of €4,806/QALY for CHOP21 and €7,235/QALY for CHOP21-R.

Conclusions Pegfilgrastim prophylaxis is an effective and cost-effective treatment for NHL patients for the Spanish NHS.

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