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- Title
Is febrile neutropenia prophylaxis with granulocyte-colony stimulating factors economically justified for adjuvant TC chemotherapy in breast cancer?
- Authors
Skedgel, Chris; Rayson, Daniel; Younis, Tallal
- Abstract
<bold>Purpose: </bold>Febrile neutropenia (FN) during adjuvant chemotherapy is associated with morbidity, mortality risk, and substantial cost, and subsequent chemotherapy dose reductions may result in poorer outcomes. Patients at high risk of, or who develop FN, often receive prophylaxis with granulocyte colony-stimulating factors (G-CSF). We investigated whether different prophylaxis strategies with G-CSF offered favorable value-for-money.<bold>Methods: </bold>We developed a decision model to estimate the short- and long-term costs and outcomes of a hypothetical cohort of women with breast cancer receiving adjuvant taxotere + cyclophosphamide (TC) chemotherapy. The short-term phase estimated upfront costs and FN risks with adjuvant TC chemotherapy without G-CSF prophylaxis (i.e., chemotherapy dose reductions) as well as with secondary and primary G-CSF prophylaxis strategies. The long-term phase estimated the expected costs and quality-adjusted life years (QALYs) for patients who completed adjuvant TC chemotherapy with or without one or more episodes of FN.<bold>Results: </bold>Secondary G-CSF was associated with lower costs and greater QALY gains than a no G-CSF strategy. Primary G-CSF appears likely to be cost-effective relative to secondary G-CSF at FN rates greater than 28%, assuming some loss of chemotherapy efficacy at lower dose intensities. The cost-effectiveness of primary vs. secondary G-CSF was sensitive to FN risk and mortality, and loss of chemotherapy efficacy following FN.<bold>Conclusions: </bold>Secondary G-CSF is more effective and less costly than a no G-CSF strategy. Primary G-CSF may be justified at higher willingness-to-pay thresholds and/or higher FN risks, but this threshold FN risk appears to be higher than the 20% rate recommended by current clinical guidelines.
- Subjects
FEBRILE neutropenia; BREAST cancer chemotherapy; GRANULOCYTE-colony stimulating factor; ADJUVANT treatment of cancer; CHEMOTHERAPY complications; CANCER-related mortality; THERAPEUTICS; DISEASE risk factors; ANTINEOPLASTIC agents; BREAST tumors; COMBINED modality therapy; COST effectiveness; DECISION making; HYDROCARBONS; PREVENTIVE health services; QUALITY-adjusted life years; CYCLOPHOSPHAMIDE; ECONOMICS
- Publication
Supportive Care in Cancer, 2016, Vol 24, Issue 1, p387
- ISSN
0941-4355
- Publication type
journal article
- DOI
10.1007/s00520-015-2805-7