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Cost-effectiveness of febrile neutropenia prevention with primary versus secondary G-CSF prophylaxis for adjuvant chemotherapy in breast cancer: a systematic review

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Abstract

The adoption of primary (PP) versus secondary prophylaxis (SP) of febrile neutropenia (FN), with granulocyte colony-stimulating factors (G-CSF), for adjuvant chemotherapy (AC) regimens in breast cancer (BC) could be affected by its “value for money”. This systematic review examined (i) cost-effectiveness of PP versus SP, (ii) FN threshold at which PP is cost-effective including the guidelines 20 % threshold and (iii) potential impact of G-CSF efficacy assumptions on outcomes. The systematic review identified all cost-effectiveness/cost-utility analyses (CEA/CUA) involving PP versus SP G-CSF for AC in BC that met predefined inclusion/exclusion criteria. Five relevant CEA/CUA were identified. These CEA/CUA examined different AC regimens (TAC = 2; FEC-D = 1; TC = 2) and G-CSF formulations (filgrastim “F” = 4; pegfilgrastim “P” = 4) with varying baseline FN—risk (range 22–32 %), mortality (range 1.4–6.0 %) and utility (range 0.33–0.47). The potential G-CSF benefit, including FN risk reduction with P versus F, varied among models. Overall, relative to SP, PP was not associated with good value for money, as per commonly utilized CE thresholds, at the baseline FN rates examined, including the consensus 20 % FN threshold, in most of these studies. The value for money associated with PP versus SP was primarily dependent on G-CSF benefit assumptions including reduced FN mortality and improved BC survival. PP G-CSF for FN prevention in BC patients undergoing AC may not be a cost-effective strategy at the guidelines 20 % FN threshold.

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Acknowledgments

The authors would like to acknowledge Ms. Robin Parker’s help with the systematic review search strategy.

Funding

Research funding was provided by the Atlantic Clinical Cancer Research Unit of the Queen Elizabeth II Health Sciences Centre.

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Authors and Affiliations

  1. Department of Medicine at Dalhousie University and the Atlantic Clinical Cancer Research Unit (ACCRU) at the Queen Elizabeth II Health Sciences Centre, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada

    T. Younis, D. Rayson & S. Jovanovic

  2. Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK

    C. Skedgel

Authors
  1. T. Younis
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  2. D. Rayson
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  3. S. Jovanovic
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  4. C. Skedgel
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Correspondence to T. Younis.

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Younis, T., Rayson, D., Jovanovic, S. et al. Cost-effectiveness of febrile neutropenia prevention with primary versus secondary G-CSF prophylaxis for adjuvant chemotherapy in breast cancer: a systematic review. Breast Cancer Res Treat 159, 425–432 (2016). https://doi.org/10.1007/s10549-016-3954-1

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  • DOI: https://doi.org/10.1007/s10549-016-3954-1

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