1553P - Cost-effectiveness of primary pegfilgrastim prophylaxis in breast cancer patients at risk of febrile neutropenia

Date 01 October 2012
Event ESMO Congress 2012
Session Poster presentation III
Topics Complications/Toxicities of Treatment
Supportive Measures
Breast Cancer
Presenter Maureen Aarts
Authors M.J. Aarts1, J.P. Grutters2, F.P. Peters3, C.M. Mandigers4, M.W. Dercksen5, J.M. Stouthard6, J.W. Nortier7, H. van Laarhoven8, L.J. van Warmerdam9, V.C. Tjan-Heijnen10
  • 1Maastricht University Medical Centre+ (MUMC+), Maastricht/NL
  • 2Department Of Health Service Research, School For Public Health And Primary Care (caphri), Maastricht University, Maastricht/NL
  • 3Medical Oncology, Orbis Medical Centre, Sittard/NL
  • 4Medical Oncology, Canisius Wilhelmina Hospital, Nijmegen/NL
  • 5Medical Oncology, Maxima Medical Centre, Veldhoven/NL
  • 6Medical Oncology, Maasstad Medical Centre, Rotterdam/NL
  • 7Medical Oncology, Leiden University Medical Centre, Leiden/NL
  • 8Medical Oncology, Radboud University Nijmegen Medical Centre and Academic Medical Centre, University of Amsterdam, Nijmegen/NL
  • 9Medical Oncology, Catharina Hospital, Eindhoven/NL
  • 10Department Of Medical Oncology, Grow-school For Oncology And Developmental Biology, Maastricht University Medical Centre+ (MUMC+), Maastricht/NL



Guidelines advise primary G-CSF prophylaxis during chemotherapy if risk of febrile neutropenia (FN) is more than 20%, but this comes with considerable costs. We investigated the incremental costs and effects between two treatment strategies of primary pegfilgrastim prophylaxis.


Our economic analysis, using a health care perspective, was based on a randomized study in breast cancer patients with increased risk of FN comparing primary G-CSF prophylaxis throughout all chemotherapy cycles (G-CSF 1-6 cycles arm) with prophylaxis during the first two cycles only (G-CSF 1-2 cycles arm). Primary outcome was the cost-effectiveness expressed as costs per patient with episodes of FN prevented.


The incidence of FN increased from 10% (8 out of 84 patients) in the G-CSF 1-6 cycles arm to 36% (30 out of 83 patients) in the G-CSF 1-2 cycles arm, whereas the mean total costs decreased from € 20,658 (95%CI € 20,049 to € 21,247) to € 17,168 (95%CI € 16,239 to € 18,029) per patient, respectively. Chemotherapy and G-CSF largely determined total costs: 83% in the G-CSF 1-6 cycles versus 78% in the G-CSF 1-2 cycles arm. As expected, FN-related costs were higher in the G-CSF 1-2 cycles arm. The incremental cost-effectiveness ratio for the G-CSF 1-6 cycles compared to the G-CSF 1-2 cycles arm was € 13,112 per patient with episode of FN prevented.


We conclude that G-CSF prophylaxis throughout all chemotherapy cycles is more effective, but more costly, compared to prophylaxis limited to the first two cycles. Whether G-CSF prophylaxis throughout all chemotherapy cycles is considered cost-effective depends on the willingness to pay per patient with episode of FN prevented.


All authors have declared no conflicts of interest.