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Evaluación económica del uso de pegfilgrastim frente a filgrastim en profilaxis primaria en pacientes con cáncer de mama con riesgo de padecer neutropenia febril en España

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PharmacoEconomics Spanish Research Articles

Resumen

Objetivos. Pegfilgrastim y filgrastim son dos tratamientos recomendados para reducir la neutropenia febril (NF) inducida por la quimioterapia. Con una cinética de eliminación regulada por la propia producción de neutrófilos, pegfilgrastim es efectivo con una única administración dentro de un período de mielosupresión, mientras que filgrastim debe ser administrado diariamente hasta que se recuperen los niveles de neutrófilos. El presente estudio evalúa la relación coste- efectividad en España de pegfilgrastim a una inyección por ciclo frente a una inyección diaria de filgrastim durante 6 días-ciclo y 11 días-ciclo en mujeres de más de 45 años con cáncer de mama sometidas a cuatro ciclos de quimioterapia, en estadio II y con un riesgo global de padecer NF ≈20% o mayor.

Métodos. Se elaboró un modelo analítico desde la perspectiva del Sistema Nacional de Salud. La información sobre la eficacia se obtuvo de la literatura. El coste por paciente se calculó a partir del coste de los medicamentos, de su administración y de las hospitalizaciones. La efectividad se midió mediante años de vida ganados (AVG) y años de vida ajustados por calidad (AVAC), mientras que la relación coste-efectividad se calculó mediante la razón costeefectividad incremental (RCEI).

Resultados. Pegfilgrastim es más eficaz y a un menor coste que filgrastim a once días/ciclo; asumiendo que el riesgo absoluto de padecer NF disminuyó en un 5,5%, se ganaron 0,06 años de vida y se ahorraron 17 € por paciente al recibir tratamiento con pegfilgrastim respecto a filgrastim. Comparando pegfilgrastim con filgrastim a seis días/ciclo, el riesgo absoluto disminuyó un 10,5% y se ganaron 0,111 años de vida. El coste medio por paciente tratado con pegfilgrastim es de 4.242 €, para filgrastim 2.779 € a seis días-ciclo. Pegfilgrastim resultó ser coste-efectivo comparado con filgrastim 6 días por ciclo con una RCEI de 13.180 €/AVG y 13.933 €/AVAC.

Conclusiones. En este modelo de pacientes con cáncer de mama con un alto riesgo de NF (≥ 20) en España, la primera profilaxis con pegfilgrastim a 6 mg por ciclo resultó en un ahorro frente a filgrastim utilizado durante 11 días-ciclo y fue coste-efectivo al compararlo con filgrastim a 6 inyecciones-ciclo.

Summary

Objectives. Pegfilgrastim and filgrastim are two recommended treatments for reducing the incidence of febrile neutropenia (FN) subsequent to cancer chemotherapy. With neutrophil-regulated kinetics, pegfilgrastim is effective with an only administration throughout the period of myelosuppression, while filgrastim must be given daily until neutrophil levels recover. The present model evaluates the cost-effectiveness in Spain of pegfilgrastim 6 mg given once per cycle compared with filgrastim used for 6 or 11 days/cycle in 45-year-old women with stage II breast cancer receiving four cycles of chemotherapy with an overall FN risk of ≈20% or higher.

Methods. An analytical model was developed from the perspective of the National Health System (SNS). Efficacy data included in the model were obtained through the literature. Costs per patient were calculated using the drugs cost, drug administration cost and the hospitalization cost. Relative efficacy was measured using the life year gained (LYG) and the years of life adjusted for quality (QALY), while cost-effectiveness was assessed through an incremental cost-effectiveness ratio (ICER).

Results. Pegfilgrastim was cost-saving compared to filgrastim used for 11 days/cycle — assuming the absolute risk of FN was decreased by 5.5%, pegfilgrastim was associated 0.06 LYG per patient and a 17 € saving. Pegfilgrastim was assumed to reduce the absolute FN incidence by 10.5% compared to 6 days of filgrastim per cycle, resulting in 0.111 LYG. The mean cost per patient treated with pegfilgrastim was 4242 € and 2779 € for those treated with filgrastim 6 days/cycle. Pegfilgrastim was therefore cost-effective compared to filgrastim 6 days/cycle with an ICER of 13.180 €/LYG and 13.933 €/QALY gained.

Conclusions. In this model of breast cancer patients at high risk of FN (≥20%) in Spain, primary prophylaxis with pegfilgrastim 6 mg per cycle was costsaving compared to filgrastim used for 11 days/cycle and cost-effective compared with filgrastim at 6 days/cycle.

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Authors and Affiliations

  1. Hospital Lozano Blesa, Zaragoza, España

    José Ignacio Mayordomo Cámara

  2. Hospital Santa Creu i Sant Pau, Barcelona, España

    Antonio López Pousa

  3. Gr. Statistics, MPH Consultant and Statistician - Health Economics and Outcomes Research IMS Health®, c/ Doctor Ferran, 25-27, 08021, Barcelona, España

    Emmanuel Giménez García, Xavier Badia Llach & Núria Lara Surinyach

  4. Amgen SA, Barcelona, España

    Francesc Sorio Vilela, Zhimei Liu & Raúl Arocho

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  1. José Ignacio Mayordomo Cámara
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Correspondence to Emmanuel Giménez García.

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Cámara, J.I.M., Pousa, A.L., García, E.G. et al. Evaluación económica del uso de pegfilgrastim frente a filgrastim en profilaxis primaria en pacientes con cáncer de mama con riesgo de padecer neutropenia febril en España. Pharmacoecon. Span. Res. Artic. 5, 71–81 (2008). https://doi.org/10.1007/BF03320844

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