OBJECTIVES: To assess number needed to treat to avoid an episode of FN (NNT) and cost-utility in the Netherlands of PP with once-per-cycle pegfilgrastim vs. no prophylaxis and vs. PP with daily G-CSF filgrastim (11-days as per label or 6-days suboptimal use) for reducing FN incidence in women with primary breast cancer receiving high risk chemotherapy for FN (e.g. TAC, a frequently used reference regimen in the Netherlands). METHODS: A decision-analytic model was constructed from healthcare-payer perspective. Costs were from official list prices (April 2013) or literature and included drugs, drug administration and FN-related medical costs and hospitalisations. Effectiveness inputs in terms of relative risk reduction (RRR) for FN were based on a recent meta-analysis. Survival and utility inputs were modeled from available data for breast cancer patients in the US and the UK. Outcomes included NNT and incremental cost effectiveness ratio (ICER) as cost per quality-adjusted life-year gained (QALY). Univariate sensitivity analyses evaluated the robustness of the model. RESULTS: NNT with pegfilgrastim PP was lowest at 4.4, with filgrastim 11-days at 5.6 and filgrastim 6-days at 13.4. In terms of cost-utility, pegfilgrastim PP was dominant vs. 11-days filgrastim PP and was considered cost-effective vs. no prophylaxis (€29,896/QALY) and vs. PP with 6-days filgrastim (€7,615/QALY). In a scenario analysis reducing the prices of daily G-CSFs by 40%, pegfilgrastim PP remained cost-effective. The sensitivity analyses revealed that most sensitive variables were FN effectiveness (relative risk reductions), incremental survival assumptions and cost of G-CSFs, and overall the model was robust to sensitivity analyses. CONCLUSIONS: In a Dutch setting, pegfilgrastim PP offers a cost-effective approach to PP of FN. In the cost-utility analysis pegfilgrastim PP was dominant vs. 11-days filgrastim PP and cost-effective vs. no prophylaxis and 6-days filgrastim PP.