Originally published as JCO Early Release 10.1200/JCO.2005.04.3281 on May 8 2006

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Cost-Effectiveness of Adding Granulocyte Colony-Stimulating Factor to Primary Prophylaxis With Antibiotics in Small-Cell Lung Cancer

Johanna N.H. Timmer-Bonte, Eddy M.M. Adang, Hans J.M. Smit, Bonne Biesma, Frank A. Wilschut, Gerben P. Bootsma, Theo M. de Boo, Vivianne C.G. Tjan-Heijnen

From the Departments of Medical Oncology, Medical Technology Assessment, Pulmonology, and Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, Nijmegen; Nijmegen Rijnstate Hospital, Arnhem; Jeroen Bosch Hospital, 's-Hertogenbosch; and Hospital Gelderse Vallei, Ede, the Netherlands

Address reprint requests to J.N.H. Timmer-Bonte, MD, 452 Department of Medical Oncology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, the Netherlands; e-mail: J.Timmer{at}onco.umcn.nl

PURPOSE: Recently, a Dutch, randomized, phase III trial demonstrated that, in small-cell lung cancer patients at risk of chemotherapy-induced febrile neutropenia (FN), the addition of granulocyte colony-stimulating factor (GCSF) to prophylactic antibiotics significantly reduced the incidence of FN in cycle 1 (24% v 10%; P = .01). We hypothesized that selecting patients at risk of FN might increase the cost-effectiveness of GCSF prophylaxis.

METHODS: Economic analysis was conducted alongside the clinical trial and was focused on the health care perspective. Primary outcome was the difference in mean total costs per patient in cycle 1 between both prophylactic strategies. Cost-effectiveness was expressed as costs per percent-FN-prevented.

RESULTS: For the first cycle, the mean incremental costs of adding GCSF amounted to 681 euro (95% CI, –36 to 1,397 euro) per patient. For the entire treatment period, the mean incremental costs were substantial (5,123 euro; 95% CI, 3,908 to 6,337 euro), despite a significant reduction in the incidence of FN and related savings in medical care consumption. The incremental cost-effectiveness ratio was 50 euro per percent decrease of the probability of FN (95% CI, –2 to 433 euro) in cycle 1, and the acceptability for this willingness to pay was approximately 50%.

CONCLUSION: Despite the selection of patients at risk of FN, the addition of GCSF to primary antibiotic prophylaxis did not result in cost savings. If policy makers are willing to pay 240 euro for each percent gain in effect (ie, 3,360 euro for a 14% reduction in FN), the addition of GCSF can be considered cost effective.

Supported by a research grant from the Dutch Healthcare Insurance Board (OG-99053).

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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