Cost-Effectiveness Analysis of PEG-rhG-CSF as Primary Prophylaxis to Chemotherapy-Induced Neutropenia in Women With Breast Cancer in China: Results Based on Real-World Data

Abstract

Background: Pegylated recombinant human granulocyte colony-stimulating factors (PEG-rhG-CSFs) are more commonly and widely used than recombinant human granulocyte colony-stimulating factors (rhG-CSFs) in preventing chemotherapy-induced neutropenia in patients with stage II-IV breast cancer. To reduce the financial burden on these patients, the corresponding medical insurance directory needs to be revised.Objectives: To evaluate the cost-effectiveness of PEG-rhG-CSF versus rhG-CSF in patients with stage II-IV breast cancer in central China.Methods: Two Markov models, a chemotherapy model and a post-chemotherapy model, were developed to study the effects and costs, with a time horizon of 12 weeks and 35 years, respectively. Cost and probability input data were primarily obtained from a retrospective real-world study conducted in five tertiary hospitals. Propensity score matching was adopted to overcome retrospective bias. Other parameters were extracted from literature as well as advice from clinical experts. Univariate and probabilistic sensitivity analyses were conducted.Results: In the first chemotherapy model, PEG-rhG-CSF was associated with fewer episodes of febrile neutropenia (FN) (N = 19 per 1000 patients treated), infections (N = 24 per 1000 patients treated) and deaths (N = 2 per 1000 patients treated), but higher costs (¥36 more per patient treated). The post-chemotherapy model indicated that PEG-rhG-CSF led to higher gains in quality-adjusted life years (QALYs) (11.695 versus 11.516) in comparison to rhG-CSF. Sensitivity analysis showed that the cost of PEG-rhG-CSF had the greatest impact on the incremental costs, and incremental QALYs were very sensitive to the risk of RDI <85%. The probability of PEG-rhG-CSF being cost-effective compared to rhG-CSF was 66% at the willingness to pay (WTP) thresholds of ¥72,371 per QALY gained.Conclusion: According to this economic evaluation based on real-world data, PEG-rhG-CSF may be considered as a more cost-effective strategy relative to rhG-CSF for stage II-IV breast cancer patients in central China. However, to reflect a national perspective, further evidence is needed using data from larger-scale studies.

Outcome and Cost-Effectiveness Analysis of Long-acting G-CSF as Primary Prophylaxis of Neutropenia Induced by Chemotherapy in Breast Cancer Patients, From a Retrospective Study

“…The costs of FN inpatient, hospitalization and infection were obtained from published literature. 16 …”

“…We assumed that the infection only occurred in the hospital. Other parameters related to the transition probability were taken from previous references 16 , 20 ( Table 1 ).…”

“…The costs of FN inpatient, hospitalization and infection were obtained from published literature. 16 The QALYs were adjusted by utility scores. The utility scores for chemotherapy, SN, and FN inpatient and outpatient were captured from published literature, 15,17,20 as shown in Table 1.…”

“…13 Results of clinical trials or real-world data were previously used to assess cost-effectiveness of the long-acting G-CSF. [14][15][16][17] The consensus was that long-acting G-CSF represented a more cost-effective strategy than the shortacting one. The analyses often concentrated on the cost and utility values associated with FN patients, since neutropenia characterized by values of neutrophil count equal or greater than 0.5 × 10 9 /L and lower than 1.8 × 10 9 /L, is frequent in clinical practice.…”

A multicenter phase II trial of primary prophylactic PEG‐rhG‐CSF in pediatric patients with solid tumors and non‐Hodgkin lymphoma after chemotherapy: An interim analysis

“…7 Therefore, the plasma half-life of PEG-rhG-CSF could be extended to up to 47 h, with preserved solubility, bioavailability, and stability. 8 Previous studies demonstrated its cost-effectiveness, safety, and comparable efficacy to conventional rhG-CSF for the management of CIN in adults, 9 children, and adolescents. 10,11 Pegfilgrastim, a PEGylated form of rhG-CSF (analog of filgrastim), was approved for use in children to reverse CIN and reduce the incidence of neutropenia-associated infections.…”