Cost-effectiveness of white blood cell growth factor use among a large nationwide cohort of elderly XXXX @entity1 treated with chemotherapy.

@entity1 @entity221 @entity1398 @entity1893 @entity2841
OBJECTIVE: To determine the cost-effectiveness (as measured as cost per life-year saved) of white blood cell growth factor or @entity2841 ( @entity2841 ) use among a large cohort of elderly @entity1893 ( @entity1893 ) @entity1 in a real-world setting. METHODS: We identified 13,203 @entity1893 @entity1 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database who received the diagnosis from 1992 to 2002 and who received chemotherapy within 12 months of diagnosis. Benefit (effectiveness) of @entity2841 use (primary and secondary prophylaxis) was measured as observed improvement in overall survival. Costs for each @entity1 were calculated by adding the cumulative reimbursement amounts from Medicare claims. Cost-effectiveness was estimated by modeling the joint influence of @entity2841 use on both costs and effectiveness using a propensity-score net monetary benefit approach. RESULTS: Primary prophylactic @entity2841 use was cost-effective at lower willingness-to-pay thresholds, whereas at higher thresholds, not providing prophylactic @entity2841 became the cost-effective strategy. For secondary prophylactic @entity2841 use among @entity1 experiencing @entity1398 , @entity221 , the opposite trend was observed. For low willingness-to-pay thresholds (< 20,000 per life-year gained), not administering @entity2841 was the cost-effective strategy, whereas @entity2841 use became cost-effective as willingness to pay increased (from  100,000+ per life-year gained). CONCLUSION: To our knowledge, this is the first large population-based study to empirically measure the cost-effectiveness of @entity2841 among @entity1893 @entity1 treated with chemotherapy. @entity2841 use as primary or secondary prophylaxis may be a cost-effective strategy depending on society's (or payers') willingness to pay for improvements in outcomes.
