Pharmacoeconomic evaluation of primary versus secondary prophylaxis with PEG-rhG-CSF in cancer patients at intermediate-to-high risk of febrile neutropenia
Objective To evaluate the economics of pegylated recombinant human granulocyte colony-stimulating factor(PEG-rhG-CSF)in primary prophylaxis and secondary prophylaxis for cancer patients at intermediate-to-high risk of febrile neutropenia(FN).Methods Decision analysis model was estalished with TreeAge software from the societal perspective in China.The main states included primary prophylaxis,secondary prophylaxis,relative dose intensity(RDI)≥85％,and RDI＜85％.Model parameters included the risk of FN,probability of FN hospitalization,cancer-related death,cancer-related utility value,direct medical cost and indirect medical cost.The model cycle was 21 days,and the simulation lasted 70 years.The primary outcomes included total cost,anti-infection cost,life years,quality-adjusted life-years(QALYs)and incremental cost-effectiveness ratio.One-way and probabilistic sensitivity analyses were conducted to assess the robustness of the results.Scenarios with different time ranges were analyzed.Results The baseline analysis showed that as compared with the secondary prophylaxis group,effectiveness was improved by 0.84 QALYs in the primary prophylaxis group,and the overall costs were reduced by 39 373 yuan,saving the anti-infection cost by 32 311 yuan.The incremental cost-effectiveness ratio was-46 722 yuan/QALY.So the primary prophylaxis was the absolute dominant regimen.In the scenario analysis of different spans,the primary prophylaxis group was superior to the secondary prophylaxis group.The probability of primary prophylaxis group was 100％at willingness-to-pay thresholds of 257 094 yuan/QALY.Conclusion Primary prophylaxis with PEG-rhG-CSF is cost-effective as compared with secondary prophylaxis for cancer patients at intermediate-to-high risk of FN.
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