聚乙二醇非格司亭
医学
发热性中性粒细胞减少症
内科学
中性粒细胞减少症
化疗
乳腺癌
粒细胞集落刺激因子
菲格拉斯汀
外科
作者
Maureen J.B. Aarts,Janneke P.C. Grutters,Femke P. Peters,Caroline Mandigers,M. W. Dercksen,Jacqueline Stouthard,J.W.R. Nortier,Hanneke W. van Laarhoven,Laurence Jc van Warmerdam,Vivianne C. G. Tjan‐Heijnen
标识
DOI:10.1016/s0923-7534(20)34175-2
摘要
ABSTRACT Purpose Guidelines advise primary G-CSF prophylaxis during chemotherapy if risk of febrile neutropenia (FN) is more than 20%, but this comes with considerable costs. We investigated the incremental costs and effects between two treatment strategies of primary pegfilgrastim prophylaxis. Methods Our economic analysis, using a health care perspective, was based on a randomized study in breast cancer patients with increased risk of FN comparing primary G-CSF prophylaxis throughout all chemotherapy cycles (G-CSF 1-6 cycles arm) with prophylaxis during the first two cycles only (G-CSF 1-2 cycles arm). Primary outcome was the cost-effectiveness expressed as costs per patient with episodes of FN prevented. Results The incidence of FN increased from 10% (8 out of 84 patients) in the G-CSF 1-6 cycles arm to 36% (30 out of 83 patients) in the G-CSF 1-2 cycles arm, whereas the mean total costs decreased from € 20,658 (95%CI € 20,049 to € 21,247) to € 17,168 (95%CI € 16,239 to € 18,029) per patient, respectively. Chemotherapy and G-CSF largely determined total costs: 83% in the G-CSF 1-6 cycles versus 78% in the G-CSF 1-2 cycles arm. As expected, FN-related costs were higher in the G-CSF 1-2 cycles arm. The incremental cost-effectiveness ratio for the G-CSF 1-6 cycles compared to the G-CSF 1-2 cycles arm was € 13,112 per patient with episode of FN prevented. Conclusion We conclude that G-CSF prophylaxis throughout all chemotherapy cycles is more effective, but more costly, compared to prophylaxis limited to the first two cycles. Whether G-CSF prophylaxis throughout all chemotherapy cycles is considered cost-effective depends on the willingness to pay per patient with episode of FN prevented. Disclosure All authors have declared no conflicts of interest.
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