Tuesday, June 18, 2024

Cost-Effectiveness of G-CSF Prophylaxis in Breast Cancer Patients: A Taiwanese Perspective

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In an effort to optimize treatment protocols for breast cancer patients undergoing high-risk chemotherapy, a study was conducted to evaluate the cost-effectiveness of granulocyte colony-stimulating factor (G-CSF) for primary and secondary prophylaxis. The research utilized a Markov model to simulate potential events during and after chemotherapy, comparing various G-CSF strategies to determine the most financially viable approach. Effectiveness data were aggregated from literature reviews and Taiwan’s National Health Insurance Research Database (NHIRD), while cost data were drawn from published NHIRD studies. The findings aim to guide Taiwan’s National Health Insurance Administration in making informed decisions that balance economic constraints with patient outcomes.

Methodology and Data Sources

A Markov model was implemented to project the sequence of events that could transpire during and post high-risk chemotherapy treatment. Different G-CSF prophylaxis strategies, including medications like pegfilgrastim and lenograstim, were evaluated within this framework. Effectiveness metrics were sourced from existing literature and NHIRD analyses, providing a robust foundation for the model. Cost data, crucial for calculating cost-effectiveness, were obtained from a published NHIRD study. Health utility values, which help assess the quality of life improvements, were also extracted from the literature. The study included sensitivity analyses to gauge the uncertainty and reliability of the cost-effectiveness outcomes.

Key Findings and Sensitivity Analysis

The base-case analysis revealed that primary prophylaxis using pegfilgrastim resulted in an incremental cost-effectiveness ratio (ICER) of NT$269,683 per quality-adjusted life year (QALY) gained, compared to primary prophylaxis with lenograstim. When lenograstim was compared to no G-CSF prophylaxis, the ICER was NT$61,995 per QALY gained. The analysis highlighted that results were most sensitive to changes in the relative risk of febrile neutropenia (FN) when using pegfilgrastim versus no G-CSF prophylaxis. Additionally, in a probabilistic sensitivity analysis, considering a willingness-to-pay threshold equivalent to Taiwan’s GDP per capita, the probability of pegfilgrastim being cost-effective was 88.1%.

Actionable Insights

  • Primary prophylaxis using pegfilgrastim is highly likely to be cost-effective, offering better economic value compared to other G-CSF strategies.
  • Lenograstim presents a more cost-effective option relative to no G-CSF prophylaxis, making it a viable alternative for budget-constrained scenarios.
  • Variations in the relative risk of FN significantly impact cost-effectiveness, indicating the need for precise risk assessments in clinical settings.
  • Given the high probability of cost-effectiveness within the Taiwanese healthcare context, policymakers should consider incorporating pegfilgrastim into standard treatment protocols.

These results underscore the potential for both short- and long-acting G-CSF to be economically justified for FN prevention among breast cancer patients undergoing high-risk chemotherapy regimens. The study provides a comprehensive analysis that can inform healthcare policies, aiming to optimize patient outcomes while maintaining fiscal responsibility.

Original Article: PLoS One. 2024 Jun 10;19(6):e0303294. doi: 10.1371/journal.pone.0303294. eCollection 2024.

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