Cost-effectiveness of granulocyte colony-stimulating factor prophylaxis in chemotherapy-induced febrile neutropenia among breast cancer and Non-Hodgkin's lymphoma patients under Taiwan's national health insurance system.
RATIONALE, AIM AND OBJECTIVE
The beneficial effects of granulocyte colony-stimulating factor (G-CSF) prophylaxis on reducing the risk of chemotherapy-induced febrile neutropenia (CIFN) were well documented throughout the literature. However, existing data regarding its cost-effectiveness were conflicting. We estimated the cost-effectiveness of G-CSF prophylaxis in CIFN under Taiwan's National Health Insurance (NHI) system.


METHODS
Data on clinical outcomes and direct medical costs were derived for 5179 newly diagnosed breast cancer and 629 non-Hodgkin's lymphoma (NHL) patients from the NHI claims database. Patients were further categorized into three subgroups as "primary-", "secondary-" and "no -" prophylaxis based on their patterns of G-CSF use. Generalized estimating equations were applied to estimate the impact of G-CSF use on the incidence of CIFN. The incremental cost-effectiveness ratios of primary and secondary prophylactic G-CSF use were calculated and sensitivity analyses were performed.


RESULTS
Primary prophylaxis of G-CSF decreased the incidence of CIFN by 27% and 83%, while secondary prophylaxis by 34% and 22% in breast cancer and NHL patients, respectively. Compared with those with no prophylaxis, the incremental cost per CIFN reduced in primary prophylaxis is $931 and $52 among patients with breast cancer and NHL, respectively. In contrast, secondary prophylaxis is dominated by no prophylaxis and primary prophylaxis in both cancer patients.


CONCLUSION
Primary but not secondary prophylactic use of G-CSF was cost-effective in CIFN in breast cancer and NHL patients under Taiwan's NHI system.
['Wen|Tsun-Jen|TJ|', 'Wen|Yu-Wen|YW|', 'Chien|Chun-Ru|CR|', 'Chiang|Shao-Chin|SC|', 'Hsu|William Wei-Yuan|WW|', 'Shen|Li-Jiuan|LJ|', 'Hsiao|Fei-Yuan|FY|']
D000328:Adult D000368:Aged D000970:Antineoplastic Agents D001943:Breast Neoplasms D064146:Chemotherapy-Induced Febrile Neutropenia D003362:Cost-Benefit Analysis D005260:Female D016179:Granulocyte Colony-Stimulating Factor D006801:Humans D008228:Lymphoma, Non-Hodgkin D008297:Male D008875:Middle Aged D009313:National Health Programs D065129:Pre-Exposure Prophylaxis D011322:Primary Prevention D012189:Retrospective Studies D055502:Secondary Prevention D013624:Taiwan
cost-effectiveness breast cancer granulocyte colony-stimulating factor (G-CSF) chemotherapy-induced febrile neutropenia (CIFN) non-Hodgkin's lymphoma (NHL) National Health Insurance Research Database (NHIRD)