Abstract | BACKGROUND: OBJECTIVE: We undertook a CEA to compare a single injection of pegfilgrastim versus repeated administrations of filgrastim in patients who had undergone PBSC transplantation for lymphoma or myeloma. The CEA was set in France and covered a period of 100 ± 10 days from transplant. METHODS: The CEA was designed as part of an open-label, multicentre, randomized phase II trial. Costs were assessed from the hospital's point of view and are expressed in 2009 euros. Costs computation focused on inpatient, outpatient, and home care. Costs in the two arms of the study were compared using the Mann-Whitney test. When differences were statistically significant, multiple regression analyses were performed in order to identify cost drivers. Incremental cost-effectiveness ratios (ICER) were calculated for the major endpoints of the trial; i.e., duration of febrile neutropenia (absolute neutrophil count [ANC] <0.5 × 10(9)/L and temperature ≥38 °C), duration of neutropenia ( ANC <1.0 × 10(9)/L and ANC <0.5 × 10(9)/L), duration of thrombopenia (platelets <50 × 10(9)/L and <20 × 10(9)/L), and days with a temperature ≥38 °C). Uncertainty around the ICER was captured by a probabilistic analysis using a non-parametric bootstrap method. RESULTS: 151 patients were enrolled at ten French centres from October 2008 to September 2009. The mean total cost in the pegfilgrastim arm of the study (n = 74) was <euro>25,024 (SD 9,945). That in the filgrastim arm (n = 76) was <euro>28,700 (SD 20,597). Pegfilgrastim strictly dominated filgrastim for days of febrile neutropenia avoided, days of neutropenia ( ANC <1.0 × 10(9)/L) avoided, days of thrombopenia (platelets <20 × 10(9)/L) avoided, and days with temperature ≥38 °C) avoided. Pegfilgrastim was less costly and less effective than filgrastim for the number of days with ANC <0.5 × 10(9)/L avoided and the number of days with platelets <50.0 × 10(9)/L avoided. Taking uncertainty into account, the probabilities that pegfilgrastim strictly dominated filgrastim were 67 % for febrile neutropenia, 86 % for neutropenia ( ANC <1.0 × 10(9)/L), 59 % for thrombopenia (platelets <20 × 10(9)/L), 86 % for temperature ≥38 °C, 32 % for neutropenia (ANC <0.5 × 10(9)/L), and 43 % for thrombopenia (platelets <50 × 10(9)/L). Conversely, the probability that filgrastim strictly dominated pegfilgrastim for neutropenia (ANC <0.5 × 10(9)/L) is 5 %. CONCLUSION:
|
Authors | Lionel Perrier, Anne Lefranc, David Pérol, Philippe Quittet, Aline Schmidt-Tanguy, Carole Siani, Christian de Peretti, Bertrand Favier, Pierre Biron, Philippe Moreau, Jacques Olivier Bay, Séverine Lissandre, Fabrice Jardin, Daniel Espinouse, Catherine Sebban |
Journal | Applied health economics and health policy
(Appl Health Econ Health Policy)
Vol. 11
Issue 2
Pg. 129-38
(Apr 2013)
ISSN: 1179-1896 [Electronic] New Zealand |
PMID | 23435861
(Publication Type: Clinical Trial, Phase II, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
|
Chemical References |
- Recombinant Proteins
- Granulocyte Colony-Stimulating Factor
- pegfilgrastim
- Polyethylene Glycols
- Filgrastim
|
Topics |
- Antineoplastic Combined Chemotherapy Protocols
(economics, therapeutic use)
- Cost-Benefit Analysis
- Drug Costs
- Drug Therapy
(economics)
- Female
- Filgrastim
- France
- Granulocyte Colony-Stimulating Factor
(economics, therapeutic use)
- Humans
- Lymphoma
(economics, therapy)
- Male
- Middle Aged
- Multiple Myeloma
(economics, therapy)
- Polyethylene Glycols
- Prospective Studies
- Recombinant Proteins
(economics, therapeutic use)
- Stem Cell Transplantation
(economics)
|
|
Join CureHunter, for free Research Interface BASIC access!
Take advantage of free CureHunter research engine access to explore the best drug and treatment options for any disease.
Find out why thousands of doctors, pharma researchers and patient activists
around the world use CureHunter every day.
Realize the full power of the drug-disease research graph!
|