Abstract
Purpose
With the emergence of biosimilar filgrastim to the market, there is a gradual decrease
in the listed price of the originator product of filgrastim over the years, and this
could have an impact on the cost-effectiveness of filgrastim in the treatment of febrile
neutropenia (FN). A cost-effectiveness analysis would allow clinicians to make informed
decision when considering the therapeutic filgrastim among low-risk FN patients. This
study aims to evaluate the cost-effectiveness of adding therapeutic filgrastim to
antibiotics in the treatment of established FN among patients with solid tumors and
lymphomas.
Methods
A decision tree model was created to compare two treatment options for established
FN as follows: (1) antibiotics alone (standard care) and (2) antibiotics with therapeutic
filgrastim (comparator). The target population was a hypothetical cohort of adult
cancer patients with solid tumors or lymphomas hospitalized with FN in Singapore.
The analysis was performed from a hospital’s perspective over a 21-day time horizon.
The main outcome measures included costs, quality-adjusted life year (QALY) and incremental
cost-effectiveness ratio (ICER). One-way sensitivity analysis and probabilistic sensitivity
analysis were conducted to evaluate the robustness of the results.
Findings
Compared with antibiotics alone, the treatment strategy of antibiotics with therapeutic
filgrastim was a dominant choice, incurring a cost saving of US$125 per patient (comparator
versus standard care: US$9110 versus US$9235) and additional health benefit of 0.0007
QALY gained per patient (comparator versus standard care: 0.0450 versus 0.0443). Model
results were robust against the parameter variations in the one-way sensitivity analyses,
but increasing the cost of filgrastim beyond US$87 per injection would increase the
ICER to >US$50,000/QALY. Furthermore, the strategy of antibiotics with therapeutic
filgrastim was the preferred choice (dominant or cost-effective) in 83.7% of the model
iterations at a willingness-to-pay threshold of US$50,000/QALY.
Implications
From a hospital’s perspective, the therapeutic filgrastim, in conjunction with antibiotics,
in the treatment of FN is cost effective. This provides evidence to support the routine
use of filgrastim for the treatment of FN among adult cancer patients with solid tumors
and lymphomas.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical TherapeuticsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Characteristics of unplanned hospital admissions due to drug-related problems in cancer patients.Supportive Care Cancer. 2014; 22: 1875-1881
- Costs associated with febrile neutropenia in solid tumor and lymphoma patients - an observational study in Singapore.BMC Health Serv Res. 2014; 14: 434
- 2010 update of EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphoproliferative disorders and solid tumours.Eur J Cancer. 2011; 47: 8-32
- Management of febrile neutropenia: ESMO Clinical Practice Guidelines.Ann Oncol. 2010; 21: v252-256
- 2006 update of recommendations for the use of white blood cell growth factors: an evidence-based clinical practice guideline.J Clin Oncol. 2006; 24: 3187-3205
Mhaskar R, Clark OA, Lyman G, et al. Colony-stimulating factors for chemotherapy-induced febrile neutropenia. Cochrane Database Syst Rev. 2014;(10):CD003039.
Amgen. 2015 Trends in Biosimilars Report. http://www.amgenbiotech.com/resources/2015_Trends_in_Biosimilars_Report-83531R1V1.pdf [Accessed June 12, 2016].
- Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America.Clin Infect Dis. 2011; 52: e56-e93
National Cancer Institute and Department of Health and Human Services (2010) Common terminology criteria for adverse events (CTCAE) v4.03. http://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_5x7.pdf [Accessed February 28, 2016].
- Clinical efficacy of adjunctive G-CSF on solid tumor and lymphoma patients with established febrile neutropenia.Support Care Cancer. 2014; 22: 1105-1112
- Blinded, randomized, multicenter study to evaluate single administration pegfilgrastim once per cycle versus daily filgrastim as an adjunct to chemotherapy in patients with high-risk stage II or stage III/IV breast cancer.J Clin Oncol. 2002; 20: 727-731
- Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia.Ann Intern Med. 1966; 64: 328-340
- Granulocyte colony-stimulating factor in the treatment of high-risk febrile neutropenia: a multicenter randomized trial.J Natl Cancer Inst. 2001; 93: 31-38
Department of Statistics Singapore. Consumer Price Index. http://www.singstat.gov.sg/statistics/browse-by-theme/prices [Accessed February 28, 2016].
The World Bank. PPP conversion factor, GDP. http://data.worldbank.org/indicator/PA.NUS.PPP [Accessed February 28, 2016].
- Psychometric Properties of the Functional Assessment of Cancer Therapy-Neutropenia in Asian cancer patients with chemotherapy-induced neutropenia.J Pain Symptom Manage. 2016; 52: 428-436
- Affordability of cancer treatment for aging cancer patients in Singapore: an analysis of health, lifestyle, and financial burden.Support Care Cancer. 2013; 21: 3509-3517
- EQ-5D value sets: inventory, comparative review and user guide.Springer, New York2007
- Factors affecting quality of life in cancer patients undergoing chemotherapy.Afr Health Sci. 2011; 11: 266-270
- Therapeutic use of granulocyte colony-stimulating factors for established febrile neutropenia: effect on costs from a hospital perspective.Pharmacoeconomics. 2007; 25: 343-351
- National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (NCCN Guidelines).Myeloid Growth Factors. v2. 2016; (https://www.nccn.org/professionals/physician_gls/pdf/myeloid_growth.pdf [Accessed June 12, 2016])
- Improving treatment of chemotherapy-induced neutropenic fever by administration of colony-stimulating factors.J Natl Cancer Inst. 1995; 87: 803-808
- Granulocyte colony-stimulating factor in established febrile neutropenia: a randomized study of pediatric patients.J Clin Oncol. 1997; 15: 1163-1170
- Antimicrobial prophylaxis and outpatient management of fever and neutropenia in adults treated for malignancy: American Society of Clinical Oncology clinical practice guideline.J Clin Oncol. 2013; 31: 794-810
- Incidence, treatment, and consequences of chemotherapy-induced febrile neutropenia in the inpatient and outpatient settings.J Oncol Pharm Pract. 2014; 20: 190-198
- Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the global burden of disease study.JAMA Oncol. 2017; 3: 524-548
Article info
Publication history
Published online: May 26, 2017
Accepted:
May 11,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
