PURPOSE: The 2006 American Society of Clinical Oncology (ASCO) guideline recommended primary prophylaxis (PP) with granulocyte colony-stimulating factor (G-CSF) instead of secondary prophylaxis (SP) for elderly patients with diffuse aggressive lymphoma receiving chemotherapy. We examined the cost-effectiveness of PP when compared with SP. METHODS: We conducted a cost-utility analysis to compare PP to SP for diffuse aggressive lymphoma. We used a Markov model with an eight-cycle chemotherapy time horizon with a government-payer perspective and Ontario health, economic, and cost data. Data for efficacies of G-CSF, probabilities, and utilities were obtained from published literature. Probabilistic sensitivity analysis (PSA) was conducted. RESULTS: The incremental cost-effectiveness ratio of PP to SP was $700,500 per quality-adjusted life-year (QALY). One-way sensitivity analyses (willingness-to-pay threshold = $100,000/QALY) showed that if PP were to be cost-effective, the cost of hospitalization for febrile neutropenia (FN) had to be more than $31,138 (2.5 × > base case), the cost of G-CSF per cycle less than $960 (base case = $1,960), the risk of first-cycle FN more than 47% (base case = 24%), or the relative risk reduction of FN with G-CSF more than 91% (base case = 41%). Our result was robust to all variables. PSA revealed a 10% probability of PP being cost-effective over SP at a willingness-to-pay threshold of $100,000/QALY. CONCLUSION: PP is not cost-effective when compared with SP in this population. PP becomes attractive only if the cost of hospitalization for FN is significantly higher or the cost of G-CSF is significantly lower.
PURPOSE: The 2006 American Society of Clinical Oncology (ASCO) guideline recommended primary prophylaxis (PP) with granulocyte colony-stimulating factor (G-CSF) instead of secondary prophylaxis (SP) for elderly patients with diffuse aggressive lymphoma receiving chemotherapy. We examined the cost-effectiveness of PP when compared with SP. METHODS: We conducted a cost-utility analysis to compare PP to SP for diffuse aggressive lymphoma. We used a Markov model with an eight-cycle chemotherapy time horizon with a government-payer perspective and Ontario health, economic, and cost data. Data for efficacies of G-CSF, probabilities, and utilities were obtained from published literature. Probabilistic sensitivity analysis (PSA) was conducted. RESULTS: The incremental cost-effectiveness ratio of PP to SP was $700,500 per quality-adjusted life-year (QALY). One-way sensitivity analyses (willingness-to-pay threshold = $100,000/QALY) showed that if PP were to be cost-effective, the cost of hospitalization for febrile neutropenia (FN) had to be more than $31,138 (2.5 × > base case), the cost of G-CSF per cycle less than $960 (base case = $1,960), the risk of first-cycle FN more than 47% (base case = 24%), or the relative risk reduction of FN with G-CSF more than 91% (base case = 41%). Our result was robust to all variables. PSA revealed a 10% probability of PP being cost-effective over SP at a willingness-to-pay threshold of $100,000/QALY. CONCLUSION: PP is not cost-effective when compared with SP in this population. PP becomes attractive only if the cost of hospitalization for FN is significantly higher or the cost of G-CSF is significantly lower.
Authors: Elena García-Martínez; Melody Smith; Aitziber Buqué; Fernando Aranda; Francisco Ayala de la Peña; Alejandra Ivars; Manuel Sanchez Cánovas; Ma Angeles Vicente Conesa; Jitka Fucikova; Radek Spisek; Laurence Zitvogel; Guido Kroemer; Lorenzo Galluzzi Journal: Oncoimmunology Date: 2018-02-15 Impact factor: 8.110
Authors: Vicki A Morrison; Edie A Weller; Thomas M Habermann; Shuli Li; Richard I Fisher; Bruce D Cheson; Bruce A Peterson Journal: Leuk Lymphoma Date: 2016-12-14
Authors: Lorenzo Galluzzi; Erika Vacchelli; José-Manuel Bravo-San Pedro; Aitziber Buqué; Laura Senovilla; Elisa Elena Baracco; Norma Bloy; Francesca Castoldi; Jean-Pierre Abastado; Patrizia Agostinis; Ron N Apte; Fernando Aranda; Maha Ayyoub; Philipp Beckhove; Jean-Yves Blay; Laura Bracci; Anne Caignard; Chiara Castelli; Federica Cavallo; Estaban Celis; Vincenzo Cerundolo; Aled Clayton; Mario P Colombo; Lisa Coussens; Madhav V Dhodapkar; Alexander M Eggermont; Douglas T Fearon; Wolf H Fridman; Jitka Fučíková; Dmitry I Gabrilovich; Jérôme Galon; Abhishek Garg; François Ghiringhelli; Giuseppe Giaccone; Eli Gilboa; Sacha Gnjatic; Axel Hoos; Anne Hosmalin; Dirk Jäger; Pawel Kalinski; Klas Kärre; Oliver Kepp; Rolf Kiessling; John M Kirkwood; Eva Klein; Alexander Knuth; Claire E Lewis; Roland Liblau; Michael T Lotze; Enrico Lugli; Jean-Pierre Mach; Fabrizio Mattei; Domenico Mavilio; Ignacio Melero; Cornelis J Melief; Elizabeth A Mittendorf; Lorenzo Moretta; Adekunke Odunsi; Hideho Okada; Anna Karolina Palucka; Marcus E Peter; Kenneth J Pienta; Angel Porgador; George C Prendergast; Gabriel A Rabinovich; Nicholas P Restifo; Naiyer Rizvi; Catherine Sautès-Fridman; Hans Schreiber; Barbara Seliger; Hiroshi Shiku; Bruno Silva-Santos; Mark J Smyth; Daniel E Speiser; Radek Spisek; Pramod K Srivastava; James E Talmadge; Eric Tartour; Sjoerd H Van Der Burg; Benoît J Van Den Eynde; Richard Vile; Hermann Wagner; Jeffrey S Weber; Theresa L Whiteside; Jedd D Wolchok; Laurence Zitvogel; Weiping Zou; Guido Kroemer Journal: Oncotarget Date: 2014-12-30
Authors: Kelly Fust; Xiaoyan Li; Michael Maschio; Guillermo Villa; Anju Parthan; Richard Barron; Milton C Weinstein; Luc Somers; Caroline Hoefkens; Gary H Lyman Journal: Pharmacoeconomics Date: 2017-04 Impact factor: 4.981