Yu Kondo1,2, Tomoya Tachi3, Takayoshi Sakakibara4, Jun Kato4, Aki Kato4, Takahito Mizuno4, Yoshio Miyake4, Hitomi Teramachi5. 1. Department of Pharmacy, Toyota Kosei Hospital, 500-1, Ibobara, Jousui-cho, Toyota, 470-0396, Japan. yu.kondoh.0327@gmail.com. 2. Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Daigaku-nishi 1-25-4, Gifu, 501-1196, Japan. yu.kondoh.0327@gmail.com. 3. Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Daigaku-nishi 1-25-4, Gifu, 501-1196, Japan. 4. Department of Pharmacy, Toyota Kosei Hospital, 500-1, Ibobara, Jousui-cho, Toyota, 470-0396, Japan. 5. Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Daigaku-nishi 1-25-4, Gifu, 501-1196, Japan. teramachih@gifu-pu.ac.jp.
Abstract
PURPOSE: The dose-limiting factor of ramucirumab plus docetaxel (RAM + DTX) in patients with non-small cell lung cancer (NSCLC) is febrile neutropenia (FN), which has a high incidence in Asians. This study aimed to evaluate the cost-effectiveness of pegfilgrastim (Peg-G) in patients with NSCLC receiving RAM + DTX in Japan. METHODS: We simulated model patients treated with RAM + DTX in Japan and developed a decision-analytical model for patients receiving Peg-G prophylaxis or no primary prophylaxis. The expected cost, quality-adjusted life-year (QALY), and incremental cost-effectiveness ratio (ICER) of each treatment were calculated from the perspective of a Japanese healthcare payer. The willingness-to-pay (WTP) threshold was set at 45,867 United States dollars (USD) (5 million Japanese yen) per QALY gained. The probabilities, utility values, and other costs were obtained from published sources. Deterministic sensitivity analysis (DSA) and probabilistic analysis were conducted to evaluate the effect of each parameter and robustness of the base-case results. RESULTS: The expected cost and QALYs were 20,275 USD and 0.701 for Peg-G prophylaxis and 17,493 USD and 0.672 for no primary prophylaxis, respectively. The ICER was calculated to be 97,519 USD per QALY gained. The results were most sensitive to FN risk with Peg-G. When FN risk with no primary prophylaxis exceeded 51% or the cost of Peg-G was less than 649 USD per injection, the ICER was below the WTP threshold. The probabilistic analysis revealed a 9.1% probability that the ICER was below the WTP threshold. CONCLUSION: Peg-G is not cost-effective in patients with NSCLC receiving RAM + DTX in Japan.
PURPOSE: The dose-limiting factor of ramucirumab plus docetaxel (RAM + DTX) in patients with non-small cell lung cancer (NSCLC) is febrile neutropenia (FN), which has a high incidence in Asians. This study aimed to evaluate the cost-effectiveness of pegfilgrastim (Peg-G) in patients with NSCLC receiving RAM + DTX in Japan. METHODS: We simulated model patients treated with RAM + DTX in Japan and developed a decision-analytical model for patients receiving Peg-G prophylaxis or no primary prophylaxis. The expected cost, quality-adjusted life-year (QALY), and incremental cost-effectiveness ratio (ICER) of each treatment were calculated from the perspective of a Japanese healthcare payer. The willingness-to-pay (WTP) threshold was set at 45,867 United States dollars (USD) (5 million Japanese yen) per QALY gained. The probabilities, utility values, and other costs were obtained from published sources. Deterministic sensitivity analysis (DSA) and probabilistic analysis were conducted to evaluate the effect of each parameter and robustness of the base-case results. RESULTS: The expected cost and QALYs were 20,275 USD and 0.701 for Peg-G prophylaxis and 17,493 USD and 0.672 for no primary prophylaxis, respectively. The ICER was calculated to be 97,519 USD per QALY gained. The results were most sensitive to FN risk with Peg-G. When FN risk with no primary prophylaxis exceeded 51% or the cost of Peg-G was less than 649 USD per injection, the ICER was below the WTP threshold. The probabilistic analysis revealed a 9.1% probability that the ICER was below the WTP threshold. CONCLUSION: Peg-G is not cost-effective in patients with NSCLC receiving RAM + DTX in Japan.
Authors: Gregory Hill; Richard Barron; Kelly Fust; Michelle E Skornicki; Douglas C A Taylor; Milton C Weinstein; Gary H Lyman Journal: J Med Econ Date: 2013-10-18 Impact factor: 2.448
Authors: Thomas J Smith; Kari Bohlke; Gary H Lyman; Kenneth R Carson; Jeffrey Crawford; Scott J Cross; John M Goldberg; James L Khatcheressian; Natasha B Leighl; Cheryl L Perkins; George Somlo; James L Wade; Antoinette J Wozniak; James O Armitage Journal: J Clin Oncol Date: 2015-07-13 Impact factor: 44.544
Authors: Edward B Garon; Tudor-Eliade Ciuleanu; Oscar Arrieta; Kumar Prabhash; Konstantinos N Syrigos; Tuncay Goksel; Keunchil Park; Vera Gorbunova; Ruben Dario Kowalyszyn; Joanna Pikiel; Grzegorz Czyzewicz; Sergey V Orlov; Conrad R Lewanski; Michael Thomas; Paolo Bidoli; Shaker Dakhil; Steven Gans; Joo-Hang Kim; Alexandru Grigorescu; Nina Karaseva; Martin Reck; Federico Cappuzzo; Ekaterine Alexandris; Andreas Sashegyi; Sergey Yurasov; Maurice Pérol Journal: Lancet Date: 2014-06-02 Impact factor: 79.321
Authors: Maureen J Aarts; Janneke P Grutters; Frank P Peters; Caroline M Mandigers; M Wouter Dercksen; Jacqueline M Stouthard; Hans J Nortier; Hanneke W van Laarhoven; Laurence J van Warmerdam; Agnes J van de Wouw; Esther M Jacobs; Vera Mattijssen; Carin C van der Rijt; Tineke J Smilde; Annette W van der Velden; Mehmet Temizkan; Erdogan Batman; Erik W Muller; Saskia M van Gastel; Manuela A Joore; George F Borm; Vivianne C Tjan-Heijnen Journal: J Clin Oncol Date: 2013-10-28 Impact factor: 44.544
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