Wang Xiao Jun, Tong Wei Xiang, Chan Alexandre
Department of Pharmacy, National University of Singapore, Singapore, Singapore; Department of Pharmacy, National Cancer Centre Singapore, Singapore, Singapore.
Department of Pharmacy, National University of Singapore, Singapore, Singapore.
Clin Ther. 2017 Jun;39(6):1161-1170. doi: 10.1016/j.clinthera.2017.05.345. Epub 2017 May 26.
With the emergence of biosimilar filgrastim to the market, there is a gradual decrease in the listed price of the originator product of filgrastim over the years, and this could have an impact on the cost-effectiveness of filgrastim in the treatment of febrile neutropenia (FN). A cost-effectiveness analysis would allow clinicians to make informed decision when considering the therapeutic filgrastim among low-risk FN patients. This study aims to evaluate the cost-effectiveness of adding therapeutic filgrastim to antibiotics in the treatment of established FN among patients with solid tumors and lymphomas.
A decision tree model was created to compare two treatment options for established FN as follows: (1) antibiotics alone (standard care) and (2) antibiotics with therapeutic filgrastim (comparator). The target population was a hypothetical cohort of adult cancer patients with solid tumors or lymphomas hospitalized with FN in Singapore. The analysis was performed from a hospital's perspective over a 21-day time horizon. The main outcome measures included costs, quality-adjusted life year (QALY) and incremental cost-effectiveness ratio (ICER). One-way sensitivity analysis and probabilistic sensitivity analysis were conducted to evaluate the robustness of the results.
Compared with antibiotics alone, the treatment strategy of antibiotics with therapeutic filgrastim was a dominant choice, incurring a cost saving of US$125 per patient (comparator versus standard care: US$9110 versus US$9235) and additional health benefit of 0.0007 QALY gained per patient (comparator versus standard care: 0.0450 versus 0.0443). Model results were robust against the parameter variations in the one-way sensitivity analyses, but increasing the cost of filgrastim beyond US$87 per injection would increase the ICER to >US$50,000/QALY. Furthermore, the strategy of antibiotics with therapeutic filgrastim was the preferred choice (dominant or cost-effective) in 83.7% of the model iterations at a willingness-to-pay threshold of US$50,000/QALY.
From a hospital's perspective, the therapeutic filgrastim, in conjunction with antibiotics, in the treatment of FN is cost effective. This provides evidence to support the routine use of filgrastim for the treatment of FN among adult cancer patients with solid tumors and lymphomas.
随着生物类似药非格司亭进入市场，多年来非格司亭原研产品的上市价格逐渐下降，这可能会影响非格司亭治疗发热性中性粒细胞减少症（FN）的成本效益。成本效益分析有助于临床医生在考虑为低风险FN患者使用非格司亭进行治疗时做出明智的决策。本研究旨在评估在实体瘤和淋巴瘤患者已确诊的FN治疗中，在抗生素治疗基础上加用非格司亭的成本效益。
构建决策树模型，比较已确诊FN的两种治疗方案如下：（1）单纯使用抗生素（标准治疗）和（2）抗生素联合治疗性非格司亭（对照方案）。目标人群为新加坡因FN住院的成年实体瘤或淋巴瘤癌症患者的假设队列。分析从医院角度在21天的时间范围内进行。主要结局指标包括成本、质量调整生命年（QALY）和增量成本效益比（ICER）。进行单因素敏感性分析和概率敏感性分析以评估结果的稳健性。
与单纯使用抗生素相比，抗生素联合治疗性非格司亭的治疗策略是更优选择，每位患者可节省成本125美元（对照方案与标准治疗：9110美元与9235美元），每位患者还可额外获得0.0007 QALY的健康效益（对照方案与标准治疗：0.0450与0.0443）。在单因素敏感性分析中，模型结果对参数变化具有稳健性，但将非格司亭每次注射成本提高到87美元以上会使ICER增加至>50,000美元/QALY。此外，在支付意愿阈值为50,000美元/QALY时，抗生素联合治疗性非格司亭的策略在83.7%的模型迭代中是首选方案（更优或具有成本效益）。
从医院角度来看，治疗性非格司亭联合抗生素治疗FN具有成本效益。这为支持在成年实体瘤和淋巴瘤癌症患者中常规使用非格司亭治疗FN提供了证据。
