Anticoagulation in Ambulatory Cancer Patients

Abstract Abstract 2071 Background: Venous thromboembolism (VTE) risk is increased in patients with malignancy, occurring in up to 20%, and is a major cause of cancer mortality. VTE prophylaxis is currently recommended for inpatients with malignancy and in those undergoing surgery (Chest 2008). Despite evidence that low molecular weight heparin (LWMH) has anti-tumor effect and improves short-term survival (Cochrane, 2011), the cost-effectiveness of anticoagulation in ambulatory cancer patients is unknown. Methods: We constructed a Markov model to evaluate prophylactic AC in ambulatory cancer patients with no previous VTE, during 4 months of chemotherapy following diagnosis. In the model, AC was enoxaparin. Major and minor bleeding risk, VTE risk, mortality, and other clinical parameters were obtained from the Cochrane 2011 analysis and other published studies. Drug costs were based on average wholesale price. Outcomes included medical costs, effectiveness measured by mortality reduction, quality-adjusted life-years (QALY), and incremental cost-effectiveness ratio (ICER) over a 24-month time horizon. Results: Base case results are shown in the Table. Compared with no LMWH, primary prophylaxis with LMWH in ambulatory cancer patients over a 4-month period was associated with a relative mortality risk of 0.92 over 24 months (relative risk reduction of 0.08), at a gain of 0.0484 QALY, for an ICER of $76,922/QALY gained, well within the accepted $100,000/QALY threshold. The results were not sensitive to variation in VTE relative risk (RR) with AC (base case RR 0.55), nor to AC-associated major bleeding (base case RR 1.3) or minor bleeding (base case RR 1.05) risks. Variation of the relative mortality risk with AC to ≥ 0.94, or the cost of AC (Figure) to ≥ $1,429/month (base $1,132), increased the ICER to >$100,000/QALY. Discussion: Prophylactic AC appears cost-effective in ambulatory cancer patients during the first four months of chemotherapy. Clinical trials will be needed to confirm the survival benefit of LMWH prophylaxis in ambulatory cancer patients. Disclosures: No relevant conflicts of interest to declare.

Download Full-text

Anticoagulation in ambulatory cancer patients with no indication for prophylactic or therapeutic anticoagulation

Thrombosis and Haemostasis ◽

10.1160/th12-03-0185 ◽

2012 ◽

Vol 108 (08) ◽

pp. 303-310 ◽

Cited By ~ 8

Author(s):

Allyson M. Pishko ◽

Kenneth J. Smith ◽

Margaret V. Ragni

Keyword(s):

Cancer Patients ◽

Mortality Risk ◽

Cochrane Review ◽

Bleeding Risk ◽

Sensitivity Analyses ◽

Base Case ◽

Minor Bleeding ◽

Relative Mortality ◽

Therapeutic Anticoagulation ◽

Life Years

SummaryVenous thromboembolism (VTE) occurs frequently in cancer patients and is a major cause of mortality. Although anticoagulation (AC) may have anti-tumour effects, it is recommended in cancer patients only for indications unrelated to these effects. A Markov model was constructed to estimate when prophylactic AC, given during four months of chemotherapy following a new cancer diagnosis, would be economically reasonable in ambulatory cancer patients with no VTE history. Risks and costs of major and minor bleeding, VTE, and death were obtained from the literature, including a 2011 Cochrane review of AC in cancer inpatients with no conventional indication. In the model, AC was low-molecular-weight-heparin (LMWH), and effects were modeled over a 24-month period. Model outputs were quality-adjusted life years (QALY) and the incremental cost-effectiveness ratio (ICER). In the base case analysis, when prophylactic AC had a two-year relative mortality risk of 0.92, there was a gain of 0.0354 QALY, for an ICER of $90,893/QALY gained, compared with no AC. In sensitivity analyses, AC prophylaxis cost less than $100,000/QALY, if two-year mortality exceeded 75%, or if AC costs were less than $1,076 per month, or if LMWH relative mortality risk was less than 0.927. Results were not sensitive to variation in VTE relative risk on AC, nor to major or minor bleeding risk on AC. A probabilistic sensitivity analysis also favoured prophylactic AC. In conclusion, prophylactic LMWH given to decrease cancer-related mortality, with no conventional indication, appears economically reasonable if its suggested mortality benefit is confirmed in future trials.

Download Full-text

Cost-effectiveness of Triple Therapy with Telaprevir for Chronic Hepatitis C Virus Patients in Germany

Journal of Health Economics and Outcomes Research ◽

10.36469/9870 ◽

2013 ◽

Vol 1 (3) ◽

pp. 239-253 ◽

Cited By ~ 9

Author(s):

Jona T. Stahmeyer ◽

Svenja Schauer ◽

Siegbert Rossol ◽

Hans Heinrich Wedemeyer ◽

Daniel Wirth ◽

...

Keyword(s):

Cost Effectiveness ◽

Hepatitis C ◽

Triple Therapy ◽

Sensitivity Analyses ◽

Healthcare Sector ◽

Base Case ◽

Life Years ◽

Previously Treated Patients ◽

Previously Treated ◽

The Cost

Background: About 400,000-500,000 people are infected with hepatitis C in Germany. Long-term consequences are the development of liver cirrhosis and hepatocellular carcinoma. The introduction of first generation protease inhibitors has significantly improved the treatment of hepatitis C genotype 1 patients. The aim of the study was to assess the cost-effectiveness of triple therapy with telaprevir in Germany. Methods: We used a Markov model on disease progression and natural history to assess the cost-effectiveness of triple therapy with telaprevir compared to standard treatment with pegylated interferon and ribavirin. Model structure and inputs were discussed with clinical experts. Deterministic and probabilistic sensitivity analyses were performed to verify the robustness of results. Results: The base-case analyses shows that triple therapy results in higher costs (untreated patients: €48,446 vs. €30,691; previously treated patients: €63,228 vs. €48,603) and better outcomes (untreated patients: 16.85 qualily of life years [QALYs] vs. 15.97 QALYs; previously treated patients: 14.16 QALYs vs. 12.89 QALYs). The incremental cost-effectiveness ratio (ICER) was €20,131 per QALY and €30,567 per life year gained (LYG) for previously untreated patients. ICER in treatment experienced patients was €7,664 per QALY for relapse patients, €12,506 per QALY for partial responders and €28,429 per QALY for null responders. Results were robust in sensitivity analyses. Conclusion: Although triple therapy with telaprevir leads to additional costs, there is a high probability of being cost-effective for different thresholds. This health economic analysis makes an important contribution to current debates on cost savings and efficient resource allocation in the German healthcare sector.

Download Full-text

P14.12 The cost-effectiveness of tumor-treating fields in patients with newly diagnosed glioblastoma

Neuro-Oncology ◽

10.1093/neuonc/noz126.247 ◽

2019 ◽

Vol 21 (Supplement_3) ◽

pp. iii68-iii69

Author(s):

X Armoiry ◽

P Auguste ◽

C Dussart ◽

J Guyotat ◽

M Connock

Keyword(s):

Cost Effectiveness ◽

Cost Effective ◽

Survival Model ◽

Sensitivity Analyses ◽

Base Case ◽

Tumor Treating Fields ◽

Kaplan Meier ◽

Life Years ◽

Secondary Analyses ◽

The Cost

Abstract BACKGROUND The addition of novel therapy “Tumor-Treating fields” (TTF) to standard radio-chemotherapy with Temozolomide (TMZ) has recently shown superiority over conventional TMZ regimen in patients with glioblastoma. Despite the clinical benefit of TTF, there is a strong concern regarding the cost of this new treatment. A first cost-effectiveness analysis, which was published in 2016, was based on effectiveness outcomes from an interim analysis of the pivotal trial and used a “standard” Markov model. Here, we aimed to update the cost-effectiveness evaluation using a partitioned survival model design and using the latest effectiveness data. MATERIAL AND METHODS A partitioned survival model was developed with three mutually exclusive health states: stable disease, progressive disease, and dead. Parametric models were fitted to the Kaplan-Meier data for overall and progression-free survival. These generated clinically plausible extrapolations beyond the observed data. The perspective of the French national health insurance was adopted and the time horizon was 20 years. Base case results were expressed as cost/life-years (LY) gained (LYG). Secondary analyses were undertaken, with the results presented as cost/per quality adjusted life years (QALY) gained. Last, we undertook deterministic and probabilistic sensitivity analyses. RESULTS After applying 4% annual discounting of benefits and costs, the base case model generated incremental benefit of 0.507 LY at a incremental cost of €258,695 yielding an incremental cost effectiveness ratio (ICER) of €510,273 / LYG. Secondary analyses yielded an ICER of €667,173/QALY. Sensitivity analyses and bootstrapping methods showed the model was relatively robust. The model was sensitive to TTF device costs and the parametric model fitted to the Kaplan-Meier data for overall survival. The cost-effectiveness acceptability curve showed TTF has 0% of being cost-effective under conventional thresholds. CONCLUSION Using a partitioned survival model, uprated costs and more mature survival outcomes, TTF when compared to standard radio-chemotherapy with TMZ is not likely to be cost-effective. This has major implications in terms of access of newly eligible patients

Download Full-text

Cost-Effectiveness of Deferasirox (Exjade®) Versus No Chelation In Patients with Lower Risk Myelodysplastic Syndromes (MDS): A Canadian Perspective

Blood ◽

10.1182/blood.v116.21.4962.4962 ◽

2010 ◽

Vol 116 (21) ◽

pp. 4962-4962

Author(s):

Khalid El Ouagari ◽

Kristen Migliaccio-Walle ◽

Helen Lau ◽

Duygu Bozkaya

Keyword(s):

Cost Effectiveness ◽

Lower Risk ◽

Chelation Therapy ◽

Sensitivity Analyses ◽

Base Case ◽

System Perspective ◽

Healthcare System Perspective ◽

Life Years ◽

The Cost ◽

Canadian Healthcare

Abstract Abstract 4962 Introduction: Guidelines for the treatment of MDS recommend iron chelation therapy (ICT) in iron-overloaded lower-risk patients with MDS and candidates for stem cell transplantation. In particular, recent reports indicate that ICT may improve overall survival (OS) in transfusion-dependent patients with low or intermediate-1 (int-1) MDS as per international prognostic scoring system (IPSS) criteria. Deferasirox is a once-daily oral chelator, with easy administration and potentially better compliance. The goal of this study is to evaluate the cost-effectiveness of deferasirox compared to receiving no chelation therapy in transfusion-dependent patients with lower-risk MDS from a Canadian healthcare system perspective. Methods: A Markov model was developed to evaluate the cost-effectiveness of deferasirox compared to receiving no chelation therapy in transfusion-dependent patients with lower-risk (eg, IPSS low or int-1) MDS. The data used in the model were obtained from published or presented studies. Model outcomes, including life years (LY) gained, quality-adjusted life years (QALYs) gained, developing complications of iron overload, progressing to acute myeloid leukemia (AML), death, and direct medical costs of ICT, transfusion, complications and AML, were estimated for each treatment group based on a simulation of 1000 patient lives. Finally, incremental cost-effectiveness ratios (ICER) were calculated as the ratio of total medical costs to LY and QALY gains. Extensive one-way sensitivity analyses were performed to examine the effects of changes in key model parameters. Probabilistic sensitivity analyses were also performed. The outcomes of the model were evaluated over a 20-year time frame and discounted annually at the rate of 5%. Costs are reported in 2009 Canadian dollars (CAD$). Results: Under base case assumptions, patients receiving deferasirox were less likely to progress to cardiac disease, AML, and death compared to patients receiving no chelation therapy. Adding deferasirox was projected to increase OS by 4.46 years (undiscounted); discounting for time, OS was projected to be increased by 2.93 years. Furthermore, undiscounted QALYs were increased by 4.20 years and discounted QALYs, by 2.99 years. The clinical benefits of deferasirox are obtained at an additional expected discounted total lifetime cost of CAD$185,429. The incremental cost-effectiveness ratios were therefore estimated to be CAD$62,001/QALY gained and CAD$63,286/LY saved. Deterministic sensitivity analyses showed the base case results to be robust with respect to variations in assumptions and estimates. The cost-effectiveness acceptability curve shows that deferasirox was preferred to no treatment in 96% of simulations when the willingness to pay for a QALY was CAD$100,000. Conclusion: The results of our analysis indicate that deferasirox offers a cost-effective treatment option for patients with lower-risk MDS as the ICER is within the thresholds that are considered acceptable (ie, $50,000 to $100,000 per QALY gained), from a Canadian healthcare system perspective. Additional clinical studies are ongoing to evaluate event-free survival with deferasirox in patients with lower-risk MDS and transfusional iron overload. Disclosures: El Ouagari: Novartis: Employment. Migliaccio-Walle: Novartis: Research Funding. Lau: Novartis: Employment. Bozkaya: Novartis: Research Funding.

Download Full-text

Cost-effectiveness of Memory Assessment Services for the diagnosis and early support of patients with dementia in England

Journal of Health Services Research & Policy ◽

10.1177/1355819617714816 ◽

2017 ◽

Vol 22 (4) ◽

pp. 226-235 ◽

Cited By ~ 5

Author(s):

Manuel Gomes ◽

Mark Pennington ◽

Raphael Wittenberg ◽

Martin Knapp ◽

Nick Black ◽

...

Keyword(s):

Cost Effectiveness ◽

Cost Effective ◽

Base Case ◽

Memory Assessment ◽

Life Years ◽

Follow Up Care ◽

Related Quality ◽

Mean Differences ◽

The Cost

Background Policy makers in England advocate referral of patients with suspected dementia to Memory Assessment Services (MAS), but it is unclear how any improvement in patients’ health-related quality of life (HRQL) compares with the associated costs. Aims To evaluate the cost-effectiveness of MAS for the diagnosis and follow-up care of patients with suspected dementia. Method We analysed observational data from 1318 patients referred to 69 MAS, and their lay carers (n = 944), who completed resource use and HRQL questionnaires at baseline, three and six months. We reported mean differences in HRQL (disease-specific DEMQOL and generic EQ-5D-3L), quality-adjusted life years (QALYs) and costs between baseline and six months after referral to MAS. We also assessed the cost-effectiveness of MAS across different patient subgroups and clinic characteristics. Results Referral to MAS was associated with gains in DEMQOL (mean gain: 3.48, 95% confidence interval: 2.84 to 4.12), EQ-5D-3L (0.023, 0.008 to 0.038) and QALYs (0.006, 0.002 to 0.01). Mean total cost over six months, assuming a societal perspective, was £1899 (£1277 to £2539). This yielded a negative incremental net monetary benefit of −£1724 (−£2388 to −£1085), assuming NICE’s recommended willingness-to-pay threshold (£30,000 per QALY). These base case results were relatively robust to alternative assumptions about costs and HRQL. There was some evidence that patients aged 80 or older benefitted more from referral to MAS (p < 0.01 from adjusted mean differences in net benefits) compared to younger patients. MAS with over 75 new patients a month or cost per patient less than £2500 over six months were relatively more cost-effective (p < 0.01) than MAS with fewer new monthly patients or higher cost per patient. Conclusions Diagnosis, treatment and follow-up care provided by MAS to patients with suspected dementia appears to be effective, but not cost-effective, in the six months after diagnosis. Longer term evidence is required before drawing conclusions about the cost-effectiveness of MAS.

Download Full-text

Enhanced recovery programme for open liver resection improves hospital costs and two-year survival without increasing costs in primary care. (Preprint)

10.2196/preprints.16829 ◽

2019 ◽

Author(s):

Chris N Jones ◽

Ben L Morrison ◽

Leigh J S Kelliher ◽

Matthew Dickinson ◽

Michael Scott ◽

...

Keyword(s):

Cost Effectiveness ◽

Liver Resection ◽

Standard Care ◽

Enhanced Recovery ◽

Study Endpoint ◽

Term Survival ◽

System Perspective ◽

Open Liver Resection ◽

Life Years ◽

The Cost

BACKGROUND The clinical benefits of enhanced recovery programmes [ERPs] have been extensively researched, but few studies have evaluated the cost-effectiveness of programmes. This study follows on from a previous randomised controlled trial. OBJECTIVE To evaluate the cost-effectiveness and impaxct upon long-term survival of an enhanced recovery after surgery programme for patients undergoing open liver resection surgery. METHODS A decision-analytic model was used to compare the study endpoint Enhanced Recovery versus standard care provided to patient with open liver resection. Outcomes obtained were costs per life-years gained. Resource use and costs were estimated from the National Health System perspective. The Decision tree and Markov Model were constructed using the original results and augmented by external data of published clinical trials. RESULTS Patients receiving Enhanced Recovery had an average life expectancy of 6.9 years versus 6.1 years in the standard group. Costs were 9538.279 GBP for ERP and 14793.05 GBP for standard treatment. This results in a cost-effectiveness ratio of -6748.33 GBP/QALY. Patients required fewer visits to their GP (p=0.006) and required less help at home with day to day activities (p=0.036). Survival at 2 years was 91.3% (ERP) vs 71.3% for the standard care group (p=0.03). CONCLUSIONS Enhanced Recovery for open liver resection can improve medium-term survival and is cost effective for both hospital and community settings. CLINICALTRIAL ISRCTN03274575 - http://www.controlled-trials.com

Download Full-text

Cost-Effectiveness of a School-Based Chlamydia Screening Program, Duval County, FL

The Journal of School Nursing ◽

10.1177/1059840519890026 ◽

2019 ◽

pp. 105984051989002 ◽

Cited By ~ 1

Author(s):

Li Yan Wang ◽

Kwame Owusu-Edusei ◽

J. Terry Parker ◽

Kristina Wilson

Keyword(s):

Cost Effectiveness ◽

Screening Program ◽

Student Participation ◽

Participation Rate ◽

Cost Effective ◽

Base Case ◽

Chlamydia Screening ◽

Program Cost ◽

Life Years ◽

The Cost

During the 2015–2016 school year, the Florida Department of Health in Duval County hosted Teen Health Centers (TeenHC) at five high schools of Jacksonville providing HIV/STD screening and pregnancy testing. The purpose of this study was to assess the cost-effectiveness of the TeenHC chlamydia screening program and determine at what student participation level, the program can be cost-effective. We assessed the costs and effectiveness of the chlamydia screening program compared with “no TeenHC”. Cost-effectiveness was measured as cost per quality-adjusted life years (QALY) gained. At a program cost of US$61,001 and 3% participation rate, the cost/QALY gained was $124,328 in the base-case analysis and $81,014–$264,271 in 95% of the simulation trials, all greater than the frequently citied $50,000/QALY benchmark. The cost/QALY gained could be <$50,000/QALY if student participation rate was >7%. The TeenHC chlamydia screening has the potential to be cost-effective. Future program efforts should focus on improving student participation.

Download Full-text

Cost-effectiveness of docetaxel in high-volume hormone-sensitive metastatic prostate cancer

Canadian Urological Association Journal ◽

10.5489/cuaj.5889 ◽

2019 ◽

Vol 13 (12) ◽

Cited By ~ 1

Author(s):

Jaclyn Beca ◽

Habeeb Majeed ◽

Kelvin K.W. Chan ◽

Sebastian J. Hotte ◽

Andrew Loblaw ◽

...

Keyword(s):

Prostate Cancer ◽

Sensitivity Analysis ◽

Cost Effectiveness ◽

Survival Data ◽

High Volume ◽

Base Case ◽

Castration Resistant Prostate Cancer ◽

Life Years ◽

Hormone Sensitive ◽

The Cost

Introduction: Three pivotal trials have considered the addition of docetaxel (D) chemotherapy to conventional androgen-deprivation therapy (ADT) for the treatment of metastatic hormone-sensitive prostate cancer (HSPC). While an initial small trial was inconclusive, two larger trials demonstrated significant clinical benefit, including pronounced survival benefits (added 17 months) among patients with high-volume metastatic disease. Given the evolving clinical evidence, the cost-effectiveness of this approach warrants exploration. Methods: The cost-effectiveness of six cycles of ADT+D compared to ADT alone to treat patients with high-volume metastatic HSPC was assessed from a Canadian public payer perspective. We included three health states: HSPC, metastatic castration-resistant prostate cancer (CRPC), and death. Survival data were obtained from the CHAARTED trial, which reported outcomes specifically for high-volume disease. We used Ontario costs data and utilities from the literature. Results: In the base case analysis, ADT+D cost an additional $25 757 and produced an extra 1.06 quality-adjusted life years (QALYs), resulting in an incremental cost-effectiveness ratio (ICER) of $24 226/QALY gained. Results from one-way sensitivity analysis across wide ranges of estimates and a range of scenarios, including an alternate model structure, produced ICERs below $35 000/QALY gained in all cases. Conclusions: The use of D with ADT in high-volume metastatic HSPC appears to be an economically attractive treatment approach. The findings were consistent with other studies and robust in sensitivity analysis across a variety of scenarios.

Download Full-text

Cost-effectiveness analysis of a physician deployment program to improve access to healthcare in rural and underserved areas in the Philippines

BMJ Open ◽

10.1136/bmjopen-2019-033455 ◽

2019 ◽

Vol 9 (12) ◽

pp. e033455

Author(s):

Anton L.V. Avanceña ◽

Kim Patrick S Tejano ◽

David W. Hutton

Keyword(s):

Cost Effectiveness ◽

Cost Effective ◽

The Philippines ◽

Cost Effectiveness Analysis ◽

Base Case ◽

Rural Municipality ◽

Healthcare Perspective ◽

Effectiveness Analysis ◽

Life Years ◽

The Cost

ObjectivesThe objective of this study is to explore the cost-effectiveness of Doctor to the Barrios (DTTB), a physician deployment program in the Philippines.DesignCost-effectiveness analysis using decision tree models with a lifetime time horizon and probabilistic sensitivity analysis.SettingSocietal and healthcare perspectives.PopulationHypothetical cohort of children under 5 years in two provinces (Aklan and Nueva Ecija) and in a representative rural municipality.ParticipantsNone.InterventionsDTTB’s impact on paediatric pneumonia and diarrhoea outcomes compared with a scenario without DTTB.Main outcome measuresCosts, effectiveness (in terms of lives saved and quality-adjusted life years (QALYs) gained) and incremental cost-effectiveness ratio (ICER).ResultsDTTB is cost-effective in the two provinces that were included in the study from societal and healthcare perspectives. Looking at a representative rural municipality, base case analysis and probabilistic sensitivity analyses suggest that DTTB has an ICER of 27 192 per QALY gained from a societal perspective. From a healthcare perspective, the base case ICER of DTTB is Philippine pesos (PHP) 71 839 per QALY gained and PHP 2 064 167 per life saved, and 10 000 Monte Carlo simulations produced similar average estimates. The cost per QALY of DTTB from a healthcare perspective is lower than the WHO recommended willingness-to-pay threshold of 100% of the country’s per-capita gross domestic product.ConclusionsDTTB can be a cost-effective intervention, but its value varies by setting and the conditions of the municipality where it is implemented. By focusing on a narrow set of paediatric outcomes, this study has likely underestimated the health benefits of DTTB. Additional research is needed to understand the full extent of DTTB’s impact on the health of communities in rural and remote areas. Future cost-effectiveness analysis should empirically estimate various parameters and include other health conditions in addition to pneumonia and diarrhoea in children.

Download Full-text

Cost-effectiveness of primary prophylaxis with pegfilgrastim in early-stage breast cancer patients receiving chemotherapy in China.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e18349 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e18349-e18349

Author(s):

Wen Xia ◽

Shusen Wang ◽

Hao Hu ◽

Fei Xu ◽

Kuikui Jiang ◽

...

Keyword(s):

Breast Cancer ◽

Cost Effectiveness ◽

Early Stage ◽

Case Fatality ◽

Primary Prophylaxis ◽

Early Stage Breast Cancer ◽

Base Case ◽

Second Phase ◽

Term Survival ◽

The Cost

e18349 Background: Guidelines recommend primary prophylaxis(PP) use for patients receiving chemotherapy regimens with a high risk of febrile neutropenia (FN), which is 20% or higher. This study aim to evaluate the cost effectiveness of PP with pegfilgrastim (Brand name:Jinyouli), PP with filgrastim or no prophylaxis in women with early-stage breast cancer(BC) in China. Methods: A two-phase Markov model was developed for a hypothetical cohort of patients age 45 with stage II BC. First phase modeled costs/outcomes of 4 cycles docetaxel combined cyclophosphamide(TC×4) chemotherapy, with assumptions based on literature reviews including FN rates(Base-case (DSA range),0.29(0.24–0.35)) and related events (FN case-fatality, 3.4 (2.7–4.1)). Second phase models the long term survival which was suggested to link with the relative dose intensity (RDI)( Mortality HR for RDI < 85% vs. ≥85%,1.45 (1.00–2.32)). Clinical effectiveness, costs, and utilities were estimated from peer-reviewed publications and expert opinions in case of unavailability of published evidences. Results: Compared to PP filgrastim and no prophylaxis, PP pegfilgrastim was associated with higher costs 5208.19RMB and 5222.73RMB respectively, and increased quality-adjusted life-year (QALY) gained 0.066 and 0.297 respectively. Accordingly, the incremental cost effectiveness ratios (ICERs) are 79146.3RMB and 17558.77 RMB per QALY, which are both below the three times GDP per capita as the willingness to pay (WTP) threshold suggested by the WHO. Conclusions: Although the cost of PP pegfilgrastim is higher, considering the additional benefits, the administrating of PP pegfilgrastim is likely to be a cost-effective alternative to PP filgrastim and no prophylaxis in patients with early stage breast cancer in China.

Download Full-text