Economic implications of using pegfilgrastim rather than conventional G-CSF to prevent neutropenia during small-cell lung cancer chemotherapy

ABSTRACT

Background: For the prevention of chemotherapy-induced febrile aplasia, a single injection of pegfilgrastim per cycle has the same efficacy as six to ten injections of conventional granulocyte colony-stimulating factor (G-CSF). However, there are few data on the economic impact of pegfilgrastim use, especially in the context of small-cell lung cancer.

Methods: This retrospective study involved 31 patients and 129 treatment cycles (32 with pegfilgrastim and 97 with granulocyte colony-stimulating factor (G-CSF)). We estimated the direct costs for preventing and managing febrile aplasia from the payer's perspective and also conducted a willingness-to-pay study with 100 healthy subjects, in order to estimate how highly a single-jab strategy was valued relative to multiple injections.

Results: The costs per cycle were respectively €1743 ± 837 and €1466 ± 836 for the pegfilgrastim and G-CSF strategies (p < 0.001). The excess cost of the pegfilgrastim strategy was partly compensated for by the perceived value of the single-jab strategy: 88% of interviewees would prefer the pegfilgrastim strategy; 16% would be willing to pay all the excess cost (€277) and 67% would be willing to pay half the excess cost.

Conclusion: In this willingness-to-pay survey, the excess cost associated with pegfilgrastim relative to other G-CSF-based prophylactic strategies is partly offset by the perceived convenience of a single injection.

Key words: :

• Pegfilgrastim
• Quality of life
• Small-cell lung cancer
• Willingness to pay

Transparency

Declaration of funding

This study has been conducted without direct or indirect sponsorship and with no involvement of the manufacturer of pegfilgrastin.

Declaration of financial/other relationships

P.T.S., D.H., M.B., G.H. have disclosed that they have no relevant financial relationships; C.C. has disclosed that he is the recipient of honoraria and speakers fees from Amgen, Lilly, Roche and is on the advisory board of Lilly; P.T. has disclosed that he is the recipient of honoraria and speakers fees from Roche, GSK and Fresenius.

All peer reviewers receive honoraria from CMRO for their review work. Peer Reviewer 1 and Peer Reviewer 2 have disclosed that they have no relevant financial relationships.

Acknowledgments

All investigators participating in the study are included as authors of this publication – they acknowledge their academic and hospital institutions for general research support.