The prophylactic use of Neulasta® (pegfilgrastim) is cost-effective for the prevention of febrile neutropenia in patients undergoing treatment for breast cancer. The details of this study appeared in the March-April 2008 issue of Value Health.
Chemotherapy remains the cornerstone of treatment for patients with cancer. Unfortunately, chemotherapy is associated with side effects such as low levels of immune cells-a condition referred to as neutropenia. Patients with neutropenia can become susceptible to infection with bacteria, viruses, and/or fungus. Among patients with neutropenia accompanied by fever (febrile neutropenia [FN]), even the slightest infection can become life-threatening. Patients with FN typically must have their treatment doses delayed or reduced, which decreases chances for the best outcomes.
Fortunately, neutropenic patients can receive blood cell boosters (growth factors) such as Neulasta, which are given by injection during chemotherapy cycles. Neulasta has the ability to reduce infections, hospitalizations, medical cost, dose delays, and death associated with infection in neutropenic patients. The FDA has approved Neulasta to be given 14 days before initiation of chemotherapy or at least 24 hours following initiation of chemotherapy. Researchers continue to evaluate the effects of Neulasta among patients who are at risk for FN.
Researchers from the Fred Hutchinson Cancer Research Center recently conducted a clinical study to evaluate the cost-effectiveness of administration of Neulasta after first and subsequent cycles of chemotherapy (primary prophylaxis) versus only after febrile neutropenia had occurred (secondary prophylaxis).
Overall results are reported as follows:
- “The incremental cost-effectiveness ratio (ICER) of Neulasta as primary versus secondary prophylaxis was $48,000 per febrile neutropenia episode avoided.”
- “Adding survival benefit from avoiding febrile neutropenia mortality yielded an ICER of $110,000/life-year gained.”
The researchers concluded: “Compared with secondary prophylaxis, the cost-effectiveness of [Neulasta] as primary prophylaxis may be equivalent or superior to other commonly used supportive care interventions in women with breast cancer.” These authors suggest that more data is needed on the direct effect of agents such as Neulasta on survival.
Reference: Ramsey SD, Liu Z, Boer R, Cost-effectiveness of primary versus secondary prophylaxis with pegfilgrastim in women with early-stage breast cancer receiving chemotherapy. Value Health [early online publication]. July 31, 2008.
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