Article Text

Pegfilgrastim for the prevention of febrile neutropenia in patients with epithelial ovarian carcinoma—a cost-effectiveness analysis
1. T. M. Numnum,
2. K. J. Kimball,
3. R. P. Rocconi,
4. L. C. Kilgore and
5. J. M. Straughn
1. Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
1. Address correspondence and reprint requests to: T. Michael Numnum, MD, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 618 South 19th Street, Old Hillman Building 538, Birmingham, AL 35233, USA. Email: tmnumnum{at}yahoo.com

## Abstract

The objective is to assess the cost-effectiveness of pegfilgrastim for the prevention of hospitalization due to febrile neutropenia (FN) in patients with epithelial ovarian carcinoma (EOC) receiving taxane/platinum-based chemotherapy. A decision analysis model evaluated a hypothetical cohort of 10,000 patients receiving six cycles of taxane/platinum-based chemotherapy for EOC. Three strategies were analyzed for the prevention of hospitalization due to FN: 1) dose modifications and delays after a hospitalization for FN without the use of granulocyte–colony stimulating factors (G-CSF) (NO G-CSF); 2) all patients receive G-CSF with each chemotherapy cycle (1° PROPHYLAXIS); 3) patients receive G-CSF for all subsequent chemotherapy cycles after a hospitalization for FN (2° PROPHYLAXIS). The model was applied to two patient populations: 1) an average-risk population (FN hospitalization rate = 5%); 2) a high-risk population (FN hospitalization rate = 16%). Using baseline assumptions in an average-risk population, NO G-CSF was the least expensive strategy with a cost of $68 million and resulted in 2,860 hospitalizations for FN. 2° PROPHYLAXIS resulted in 141 fewer hospitalizations than NO G-CSF at a cost of$76,288 per hospitalization prevented. 1° PROPHYLAXIS was the most effective and resulted in 1,689 fewer hospitalizations for FN compared to NO G-CSF at a cost of \$47,343 per hospitalization prevented. When this model is applied to a high-risk patient population, 1° PROPHYLAXIS is more effective and less expensive than both NO G-CSF and 2° PROPHYLAXIS. We conclude that in average-risk patients receiving chemotherapy for EOC the use of pegfilgrastim is effective at reducing hospitalizations due to FN, but at a significant cost. However, in high-risk patients, primary prophylaxis is the only cost-effective strategy and should be strongly considered.

• cost-effectiveness analysis
• granulocyte-colony stimulating factor
• ovarian cancer
• pegfilgrastim

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