Cost-Effectiveness of Primary Pegfilgrastim Prophylaxis in Breast Cancer Patients at Risk of Febrile Neutropenia

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.