OptumInsight, Cambridge, MA, USA.
Amgen Inc., Thousand Oaks, CA, USA.
Gynecol Oncol. 2014 Jun;133(3):446-53. doi: 10.1016/j.ygyno.2014.03.014. Epub 2014 Mar 19.
Evaluate the cost-effectiveness of primary prophylaxis (PP) or secondary prophylaxis (SP) with pegfilgrastim, filgrastim (6-day and 11-day), or no prophylaxis to reduce the risk of febrile neutropenia (FN) in patients with recurrent ovarian cancer receiving docetaxel or topotecan.
A Markov model was used to evaluate the cost-effectiveness of PP vs SP from a US payer perspective. Model inputs, including the efficacy of each strategy (relative risk of FN with prophylaxis compared to no prophylaxis) and mortality, costs, and utility values were estimated from public sources and peer-reviewed publications. Incremental cost-effectiveness was evaluated in terms of net cost per FN event avoided, incremental cost per life-year saved (LYS), and incremental cost per quality-adjusted life-year (QALY) gained over a lifetime horizon. Deterministic and probabilistic sensitivity analyses (DSA and PSA) were conducted.
For patients receiving docetaxel, the incremental cost-effectiveness ratio (ICER) for PP vs SP with pegfilgrastim was $7900 per QALY gained, and PP with pegfilgrastim dominated all other comparators. For patients receiving topotecan, PP with pegfilgrastim dominated all comparators. Model results were most sensitive to baseline FN risk. PP vs SP with pegfilgrastim was cost effective in 68% and 83% of simulations for docetaxel and in >99% of simulations for topotecan at willingness-to-pay thresholds of $50,000 and $100,000 per QALY.
PP with pegfilgrastim should be considered cost effective compared to other prophylaxis strategies in patients with recurrent ovarian cancer receiving docetaxel or topotecan with a high risk of FN.
评估培非格司亭、非格司亭（6 天和 11 天方案）或无预防治疗用于降低接受多西他赛或拓扑替康治疗的复发性卵巢癌患者发生发热性中性粒细胞减少症（FN）风险的成本效果。
采用马尔可夫模型从美国支付者角度评估初级预防（PP）与次级预防（SP）的成本效果。模型输入包括每种策略的疗效（预防治疗与无预防治疗相比 FN 的相对风险）和死亡率、成本以及效用值，均来自公共资源和同行评议文献。以避免每例 FN 事件的净成本、每例生命年节省的增量成本（LYS）和每例质量调整生命年（QALY）的增量成本来评估增量成本效果。进行了确定性和概率敏感性分析（DSA 和 PSA）。
对于接受多西他赛治疗的患者，与 SP 相比，PP 联合培非格司亭的增量成本效果比（ICER）为每获得一个 QALY 增加 7900 美元，且 PP 联合培非格司亭优于所有其他对照物。对于接受拓扑替康治疗的患者，PP 联合培非格司亭优于所有对照物。模型结果对 FN 风险基线最敏感。对于多西他赛，PP 联合培非格司亭在愿意支付每 QALY 50000 美元和 100000 美元的阈值下，68%和 83%的模拟中，与 SP 相比具有成本效果，对于拓扑替康，>99%的模拟中，与 SP 相比具有成本效果。
对于 FN 风险较高的接受多西他赛或拓扑替康治疗的复发性卵巢癌患者，与其他预防策略相比，PP 联合培非格司亭应被认为具有成本效果。
