Cost-Effectiveness of Pegfilgrastim Versus 5-day Filgrastim in Early Breast Cancer Patients Undergoing Neoadjuvant and Adjuvant Chemotherapy: A Trial-Based Economic Evaluation
Author(s)
Kathy Tong, BHSc1, Terry Ng, MD2, Cacy Tran, BSc3, Alyssa Grant, PhD3, Arif Awan, MD2, Mark Clemons, MD2, Daniel Davoudoir, Msc4, Rakesh Goel, MD2, Peter Greenstreet, PhD3, John Hilton, MD2, Mohammed Ibrahim, MD5, Natalie Mills, MD6, Stuart Nicholls, PhD7, Moira Rushton, MD2, Marie-France Savard, MD2, Sandeep Sehdev, MD2, Jennifer Shamess, MSc8, Xinni Song, MD2, Carol Stober, RPhT3, Monica Taljaard, PhD7, Lisa Vandermeer, Msc3, Kednapa Thavorn, PhD3.
1Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada, 2Ottawa Hospital Cancer Centre, Ottawa, ON, Canada, 3Ottawa Hospital Research Institute, Ottawa, ON, Canada, 4Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada, 5Northern Ontario School of Medicine University, Thunder Bay, ON, Canada, 6St. Joseph Family Medical Clinic, Thunder Bay, ON, Canada, 7Methodological and Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada, 8Champlain Regional Cancer Care Patient and Family Advisory Council, Toronto, ON, Canada.
1Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada, 2Ottawa Hospital Cancer Centre, Ottawa, ON, Canada, 3Ottawa Hospital Research Institute, Ottawa, ON, Canada, 4Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada, 5Northern Ontario School of Medicine University, Thunder Bay, ON, Canada, 6St. Joseph Family Medical Clinic, Thunder Bay, ON, Canada, 7Methodological and Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada, 8Champlain Regional Cancer Care Patient and Family Advisory Council, Toronto, ON, Canada.
OBJECTIVES: Febrile neutropenia (FN) during adjuvant chemotherapy poses risks of morbidity and costs. A randomized trial found comparable quality-of-life outcomes but higher FN and hospitalization rates with 5-day filgrastim (FIL) compared to pegfilgrastim (PEG) in early-stage breast cancer (EBC). This study assesses the cost-effectiveness of PEG versus 5-Day FIL from the perspective of Canada’s healthcare system.
METHODS: We developed a probabilistic decision tree to estimate the total costs and quality-adjusted life years (QALYs) of EBC patients receiving either PEG or 5-day FIL over the trial follow-up period. Efficacy data for PEG versus 5-day FIL, health care utilization and health utility values were obtained from the REaCT-5G trial. Unit costs were sourced from Canadian public databases. Health utility values were derived from the EQ-5D-5L questionnaire, and QALYs were calculated using the area-under-the-curve method. Baseline health utility values were adjusted using linear regression. A series of sensitivity and scenario analyses will be conducted to evaluate the robustness of the results, including assumptions regarding the long-term effects of granulocyte colony-stimulating factor, specifically FIL and PEG.
RESULTS: Hospitalization rates were significantly lower in the PEG group (1.8%) compared to the FIL group (10.2%), with a mean difference of 8.4% (95% CI: 1.2 to 15.5). The incidence of FN was comparable between the PEG and FIL groups, with a mean difference of 4.6% (95% CI: -0.3 to 9.5). Moreover, no statistically significant differences were observed in health utility scores (0.0010 [95% CI: -0.0099 to 0.0119]) or QALYs (0.0032 [95% CI: -0.044 to 0.050]). A cost-utility analysis is currently underway and will be presented at the conference.
CONCLUSIONS: PEG was associated with fewer hospitalizations, comparable FN incidence, and similar QLAYs compared to 5-day FIL, suggesting it may be the preferred option for EBC patients. A cost-effectiveness analysis is ongoing.
METHODS: We developed a probabilistic decision tree to estimate the total costs and quality-adjusted life years (QALYs) of EBC patients receiving either PEG or 5-day FIL over the trial follow-up period. Efficacy data for PEG versus 5-day FIL, health care utilization and health utility values were obtained from the REaCT-5G trial. Unit costs were sourced from Canadian public databases. Health utility values were derived from the EQ-5D-5L questionnaire, and QALYs were calculated using the area-under-the-curve method. Baseline health utility values were adjusted using linear regression. A series of sensitivity and scenario analyses will be conducted to evaluate the robustness of the results, including assumptions regarding the long-term effects of granulocyte colony-stimulating factor, specifically FIL and PEG.
RESULTS: Hospitalization rates were significantly lower in the PEG group (1.8%) compared to the FIL group (10.2%), with a mean difference of 8.4% (95% CI: 1.2 to 15.5). The incidence of FN was comparable between the PEG and FIL groups, with a mean difference of 4.6% (95% CI: -0.3 to 9.5). Moreover, no statistically significant differences were observed in health utility scores (0.0010 [95% CI: -0.0099 to 0.0119]) or QALYs (0.0032 [95% CI: -0.044 to 0.050]). A cost-utility analysis is currently underway and will be presented at the conference.
CONCLUSIONS: PEG was associated with fewer hospitalizations, comparable FN incidence, and similar QLAYs compared to 5-day FIL, suggesting it may be the preferred option for EBC patients. A cost-effectiveness analysis is ongoing.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE476
Topic
Economic Evaluation
Topic Subcategory
Trial-Based Economic Evaluation
Disease
SDC: Oncology