(ChemotherapyAdvisor) – Primary prophylaxis with granulocyte colony-stimulating factor (G-CSF) in elderly patients with diffuse large B-cell lymphoma (DLBCL) receiving curative-intent chemotherapy is not cost effective compared with secondary prophylaxis, according to a study in the Journal of Clinical Oncology online March 5.

In fact, “primary prophylaxis becomes attractive only if the cost of hospitalization for febrile neutropenia is significantly higher or the cost of G-CSF is significantly lower,” the investigators found.

They examined costs of administering G-CSF as primary or secondary prophylaxis in light of the 2006 American Society of Clinical Oncology guideline recommending primary over secondary prophylaxis in this patient population. The rationale for the recommendation is that primary prophylaxis may reduce hospitalization and improve quality of life by reducing morbidities arising from febrile neutropenia, the observed risk of which is highest in the first cycle of chemotherapy.

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The base case consisted of elderly patients (age ≥65 years) with newly diagnosed DLBCL being treated with curative intent. The cost-utility analysis used a Markov model with an 8-cycle time horizon of chemotherapy with a government-payer perspective. Health, economic, and cost data from Ontario, Canada, were used; the literature provided data for efficacies of G-CSF, probabilities, and utilities.

Incremental cost-effectiveness ratio of primary prophylaxis to secondary prophylaxis was $700,500 per quality-adjusted life-year (QALY). One-way sensitivity analyses (willingness-to-pay threshold=$100,000/QALY) showed that if primary prophylaxis were to be cost-effective, hospitalization cost for febrile neutropenia had to be >$31,138; cost of G-CSF per cycle <$960; risk of first-cycle febrile neutropenia >47%; or relative risk reduction of febrile neutropenia with G-CSF >91%.

“As modern anticancer therapy becomes increasingly expensive, limited healthcare resources should be allocated to therapies with more value to provide maximal benefits to our patients and ensure sustainability of our health care system,” they concluded.