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. 2023 Jan-Dec:30:10732748221140289.
doi: 10.1177/10732748221140289.

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

Yaqin Wang  1 , Chenglong Zhao  1 , Peizhi Ma  1 , Dandan Jiang  1
Affiliations

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

Yaqin Wang et al. Cancer Control. 2023 Jan-Dec.

Abstract

Purpose: This retrospective analysis aimed to evaluate the clinical outcomes and cost-effectiveness of long-acting granulocyte-colony stimulating factor as primary prophylaxis of neutropenia caused by chemotherapy for breast cancer.

Methods: Patients with breast cancer who received long- or short-acting granulocyte-colony stimulating factor as primary prophylaxis of neutropenia were enrolled in this study, and incidences of neutropenia were compared between two groups. A decision-analytic and a Markov model were used to compare the health benefits and costs of utilizing long- vs short-acting granulocyte-colony stimulating factor as the primary prophylaxis from the perspective of the Chinese health service system. Subsequently, one-way deterministic and probabilistic sensitivity analyses were conducted. The incremental cost-effectiveness ratios were calculated in baseline and sensitivity analyses.

Results: Patients receiving long-acting granulocyte-colony stimulating factor as the primary prophylaxis of chemotherapy-induced neutropenia experienced a significant lower incidence of this adverse event, compared with the short-acting one for 2 to 7 days. The outcomes of baseline analysis indicated that long-acting granulocyte-colony stimulating factor had a gain of 0.08 quality-adjusted life years and costed $149 more than the short-acting one, yielding an incremental cost-effectiveness ratio of $1792 per quality-adjusted life year. The sensitivity analysis proved the stability of our models and economic efficiency of long-acting granulocyte-colony stimulating factor.

Conclusions: Patients receiving long-acting granulocyte-colony stimulating factor as primary prophylaxis of neutropenia experienced lower risk of this event compared with those underusing short-acting one. The long-acting granulocyte-colony stimulating factor may be a more cost-effective strategy for primary prophylaxis of neutropenia than short-acting one, considering the Chinese willingness-to-pay threshold of $12158.6 per quality-adjusted life year.

Keywords: ICER; chemotherapy-induced neutropenia; cost-effectiveness; granulocyte-colony stimulating factor; quality-adjusted life year.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Model structures including a decision-analytic model (A) and a Markov model (B). G-CSF, the granulocyte-colony stimulating factor; SN, severe neutropenia; FN, febrile neutropenia; RDI, relative dose intensity.
Figure 2.
Figure 2.
The incidences of neutropenia in patients receiving long or short G-CSF as primary prophylaxis following chemotherapy. G-CSF, the granulocyte-colony stimulating factor; SN, severe neutropenia; FN, febrile neutropenia.
Figure 3.
Figure 3.
Tornado diagram of the one-way deterministic sensitivity analysis on costs, utilities and partial parameters on transition probabilities (A), and incidences of non-SN, SN and FN (B). SN, severe neutropenia; FN, febrile neutropenia; G-CSF, the granulocyte-colony stimulating factor; ANC, absolute neutrophil count; Max, maximum value of each parameter; Min, minimum value of each parameter.
Figure 4.
Figure 4.
Scatterplot of probabilistic sensitivity analysis for 5000 simulations. QALYs, quality-adjusted life years; WTP: willingness-to-pay.
Figure 5.
Figure 5.
Cost-effectiveness acceptability curves for long or short G-CSF as primary prophylaxis of neutropenia. WTP, the willingness-to-pay.
See this image and copyright information in PMC

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