OBJECTIVES: To examine the cost-effectiveness of lipegfilgrastim versus pegfilgrastim as primary prophylaxis in women with early stage breast cancer.

METHODS: Two Markov models including a chemotherapy and a post-chemotherapy models were constructed with a time horizon of 12 weeks and 30 years, respectively. All the transition probabilities and utility weights were derived from clinical trials and/or published literatures. The costs populated in the chemotherapy model were extracted from Medicare, Pharmaceutical Benefit Scheme and the Independent Hospital Pricing Authority. No cost was considered in the post-chemotherapy model. Sensitivity analyses were performed to test the robustness of the results.

RESULTS: From the first chemotherapy model, lipegfilgrastim was associated with fewer episodes of severe neutropenia (SN) (N=142 per 1000 patients treated), febrile neutropenia (FN) (N=29 per 1000 patients treated), infection (N=17 per 1000 patients treated) and chemotherapy delayed (N=17 per 1000 patients treated) and lower cost ($116.88 less per patient treated). The post-chemotherapy model indicated lipegfilgrastim led to higher gains in both life years (18.72 vs 18.61) and Quality-adjusted life years (17.28 vs 17.18) in comparison to pegfilgrastim. Sensitivity analysis showed that the results from the chemotherapy model is very sensitive to the baseline risk of SN; while from the probabilistic sensitivity analysis, lipegfilgrastim was likely to be more cost-effective than pegfilgrastim based on two models.

CONCLUSIONS: The administrating of lipegfilgrastim was likely to be a cost-effective alternative to pegfilgrastim as primary prophylaxis in patients with early stage breast cancer and it was associated with greater long term survival primarily due to the reduced FN-related mortality and increased likelihood of completing the full course and dose of chemotherapy. It should be noted that from the sensitivity analysis the confidence interval for the cost and benefit outcomes overlapped to a great extent, suggesting an insignificant difference between lipegfilgrastim and pegfilgrastim.