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

Published

Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Billingsley, CC; Cohn, DE; Crim, AK; Li, Q; O'Malley, DM; Havrilesky, LJ

Published Date

  • 2018

Published In

Volume / Issue

  • 14 /

Start / End Page

  • 21 - 25

PubMed ID

  • 30104004

Pubmed Central ID

  • 30104004

Electronic International Standard Serial Number (EISSN)

  • 2468-2942

Digital Object Identifier (DOI)

  • 10.1016/j.ctarc.2017.11.003

Language

  • eng

Conference Location

  • England