Drug Combinations Cost-Effective for Reducing Febrile Neutropenia in Patients With Non-Hodgkin Lymphoma

03/08/16

A study comparing seven prophylaxis strategies for reducing the risk of febrile neutropenia (FN) in patients with non-Hodgkin lymphoma receiving chemotherapy found that routine primary prophylaxis (PP) with nivestim or pegfilgrastim is cost-effective. 

FN is a major complication of suppressive chemotherapy and is often associated with a high economic burden. In a study published in Plos One, researchers from the National Cancer Centre Singapore compared the cost-effectiveness of seven FN prophylaxis strategies using the drug nivestim or the drug pegfilgrastim. 

Researchers, led by Alexandre Chan, PharmD, MPH, National University of Singapore (Singapore, Singapore), analyzed data obtained from various national studies of patients hospitalized for FN after chemotherapy treatment for non-Hodgkin lymphoma. To simplify results, all cases of FN were assumed to require hospitalization, and cost-effectiveness was expressed as the cost per episode of FN avoided over six cycles of chemotherapy.

Specifically, the team compared the following regimens: (1) PP with nivestim through all cycles of chemotherapy; (2) PP with nivestim during the first two cycles of chemotherapy; (3) secondary prophylaxis with nivestim; (4) PP with pegfilgrastim through all cycles of chemotherapy; (5) PP with pegfilgrastim during the first two cycles of chemotherapy; (6) secondary prophylaxis with pegfilgrastim; and (7) no prophylaxis.

Of these strategies, PP with nivestim or pegfilgrastim either during chemotherapy cycles 1 and 2 or during all cycles of chemotherapy were found to be the most cost-effective strategies, compared with secondary prophylaxis or not offering prophylaxis altogether. The respective costs associated with PP with nivestim during cycles 1 and 2, PP with pegfilgrastim during cycles 1 and 2, PP with nivestim through all cycles, and PP with pegfilgrastim during all cycles were $3813, $4056, $4545, and $5331. 

The incremental cost-effectiveness ratio (ICER) for PP with pegfilgrastim during cycles 1 and 2 compared with PP with nivestim during cycles 1 and 2 was $13,532 per episode of FN prevented. For PP with nivestim during all cycles compared with PP with pegfilgrastim during cycles 1 and 2, the ICER was $22,565 per episode of FN prevented. For PP with pegfilgrastim during all cycles compared with PP with nivestim during all cycles, the ICER was $30,452 per episode of FN prevented.

After additional statistical analysis, the team also found that when the willingness to pay (WTP) threshold was lower than $10,000 per episode, PP with nivestim during cycles 1 and 2 had the highest probability of being cost-effective.  However, when WTP threshold was set at $20,000 per episode, PP with either nivestim or pegfilgrastim for all cycles had the highest probability of being cost-effective. 

Dr Chan and his coauthors concluded that PP with nivestim or pegfilgrastim is cost-effective for reducing FN risk in patients with non-Hodgkin lymphoma receiving chemotherapy.—Sean McGuire

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Wang XJ, Tang T, Farid M, et al. Routine primary prophylaxis for febrile neutropenia with biosimilar granulocyte colony-stimulating factor (nivestim) or pegfilgrastim is cost effective in non-Hodgkin lymphoma patients undergoing curative-intent R-CHOP chemotherapy. [Published online February 12, 2016]. PLoS One. 2016. doi: 10.1371/journal.pone.0148901.