Cost Effectiveness of Pegfilgrastim Versus Filgrastim After High-Dose Chemotherapy and Autologous Stem Cell Transplantation in Patients with Lymphoma and Myeloma

Autor: Philippe Moreau, Fabrice Jardin, Jacques-Olivier Bay, Pierre Biron, David Pérol, Catherine Sebban, Philippe Quittet, Bertrand Favier, Christian de Peretti, Aline Schmidt-Tanguy, Lionel Perrier, Daniel Espinouse, Carole Siani, Anne Lefranc, Severine Lissandre
Rok vydání: 2013
Předmět:
Zdroj: Applied Health Economics and Health Policy. 11:129-138
ISSN: 1179-1896
1175-5652
DOI: 10.1007/s40258-013-0011-7
Popis: Use of the recombinant human granulocyte colony-stimulating factor (rhG-CSF) filgrastim accelerates neutrophil recovery following myelosuppressive chemotherapy. Since filgrastim requires multiple daily administrations, forms of rhG-CSF with a longer half life, including pegfilgrastim, have been developed. Pegfilgrastim is safe and effective in supporting neutrophil recovery and reducing febrile neutropenia after conventional chemotherapy. Pegfilgrastim has also been successfully used to support patients undergoing peripheral blood stem cell (PBSC) transplantation for haematological malignancies. To our knowledge, no cost-effectiveness analysis (CEA) of pegfilgrastim in this setting has been published yet.We undertook a CEA to compare a single injection of pegfilgrastim versus repeated administrations of filgrastim in patients who had undergone PBSC transplantation for lymphoma or myeloma. The CEA was set in France and covered a period of 100 ± 10 days from transplant.The CEA was designed as part of an open-label, multicentre, randomized phase II trial. Costs were assessed from the hospital's point of view and are expressed in 2009 euros. Costs computation focused on inpatient, outpatient, and home care. Costs in the two arms of the study were compared using the Mann-Whitney test. When differences were statistically significant, multiple regression analyses were performed in order to identify cost drivers. Incremental cost-effectiveness ratios (ICER) were calculated for the major endpoints of the trial; i.e., duration of febrile neutropenia (absolute neutrophil count [ANC]0.5 × 10(9)/L and temperature ≥38 °C), duration of neutropenia (ANC1.0 × 10(9)/L and ANC0.5 × 10(9)/L), duration of thrombopenia (platelets50 × 10(9)/L and20 × 10(9)/L), and days with a temperature ≥38 °C). Uncertainty around the ICER was captured by a probabilistic analysis using a non-parametric bootstrap method.151 patients were enrolled at ten French centres from October 2008 to September 2009. The mean total cost in the pegfilgrastim arm of the study (n = 74) waseuro25,024 (SD 9,945). That in the filgrastim arm (n = 76) waseuro28,700 (SD 20,597). Pegfilgrastim strictly dominated filgrastim for days of febrile neutropenia avoided, days of neutropenia (ANC1.0 × 10(9)/L) avoided, days of thrombopenia (platelets20 × 10(9)/L) avoided, and days with temperature ≥38 °C) avoided. Pegfilgrastim was less costly and less effective than filgrastim for the number of days with ANC0.5 × 10(9)/L avoided and the number of days with platelets50.0 × 10(9)/L avoided. Taking uncertainty into account, the probabilities that pegfilgrastim strictly dominated filgrastim were 67 % for febrile neutropenia, 86 % for neutropenia (ANC1.0 × 10(9)/L), 59 % for thrombopenia (platelets20 × 10(9)/L), 86 % for temperature ≥38 °C, 32 % for neutropenia (ANC0.5 × 10(9)/L), and 43 % for thrombopenia (platelets50 × 10(9)/L). Conversely, the probability that filgrastim strictly dominated pegfilgrastim for neutropenia (ANC0.5 × 10(9)/L) is 5 %.This study found no evidence that the use of pegfilgrastim is associated with greater cost in lymphoma and myeloma patients after high-dose chemotherapy and PBSC transplantation.
Databáze: OpenAIRE
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