Cost-effectiveness analysis of febrile neutropenia (FN) prophylaxis with pegfilgrastim in non-Hodgkin's lymphoma (NHL) patients treated with chemotherapy in Spain

Background Granulocyte-colony stimulating factor (G-CSF) prophylaxis reduces the risk of FN in NHL patients receiving myelosuppressive chemotherapy. Purpose To estimate incremental cost-effectiveness ratios (ICERs) of pegfilgrastim prophylaxis versus other prophylaxis strategies in NHL patients from the perspective of the Spanish NHS. Materials and methods A Markov model simulated lifetime effectiveness (quality adjusted life years-QALYs) and cost (€2011) in NHL patients receiving CHOP21±R. Pegfilgrastim was compared with 11-day filgrastim (Neupogen), 6-day filgrastim, and no prophylaxis (no use of G-CSF); these strategies were compared within primary (PP) and secondary (SP) prophylaxis. Model inputs were: risk of FN, mortality, probability of relative dose intensity RDI Results Effectiveness analyses (QALYs) demonstrated pegfilgrastim-PP was the most effective treatment. Assuming an accepted threshold of €30,000/QALY, PP with pegfilgrastim versus other PP strategies was cost-effective for CHOP21 (ICER of pegfilgrastim vs 11-day filgrastim, 6-day filgrastim or no prophylaxis of €3,606, €8,383 and €14,881 per QALY, respectively) and CHOP21-R (ICER of pegfilgrastim vs 11-day filgrastim, 6-day filgrastim or no prophylaxis of €5,895, €11,433 and €18,898 per QALY, respectively). Similarly, SP with pegfilgrastim versus other SP strategies was cost-effective, being the dominant SP strategy (more effective and less costly) versus 11- and 6-day filgrastim for CHOP21 and 11-day filgrastim for CHOP21-R. Compared to no prophylaxis, pegfilgrastim-SP had an ICER of €4,806/QALY for CHOP21 and €7,235/QALY for CHOP21-R. Conclusions Pegfilgrastim prophylaxis is an effective and cost-effective treatment for NHL patients for the Spanish NHS.