RESUMEN
OBJECTIVE: Prophylaxis with granulocyte colony-stimulating factor (G-CSF) reduces the risk of febrile neutropenia (FN) in patients receiving myelosuppressive chemotherapy. We estimated the incremental cost-effectiveness of G-CSF pegfilgrastim primary (starting in cycle 1 and continuing in subsequent cycles of chemotherapy) versus secondary (only after an FN event) prophylaxis in women with early-stage breast cancer receiving myelosuppressive chemotherapy with a >or=20% FN risk. METHODS: A decision-analytic model was constructed from a health insurer's perspective with a lifetime study horizon. The model considers direct medical costs and outcomes related to reduced FN and potential survival benefits because of reduced FN-related mortality. Inputs for the model were obtained from the medical literature. Sensitivity analyses were conducted across plausible ranges in parameter values. RESULTS: The incremental cost-effectiveness ratio (ICER) of pegfilgrastim as primary versus secondary prophylaxis was $48,000/FN episode avoided. Adding survival benefit from avoiding FN mortality yielded an ICER of $110,000/life-year gained (LYG) or $116,000/quality-adjusted life-year (QALY) gained. The most influential factors included FN case-fatality, FN relative risk reduction from primary prophylaxis, and age at diagnosis. CONCLUSIONS: Compared with secondary prophylaxis, the cost-effectiveness of pegfilgrastim as primary prophylaxis may be equivalent or superior to other commonly used supportive care interventions for women with breast cancer. Further assessment of the direct impact of G-CSF on short- and long-term survival is needed to substantiate these findings.
Asunto(s)
Neoplasias de la Mama/tratamiento farmacológico , Factor Estimulante de Colonias de Granulocitos/economía , Neutropenia/prevención & control , Prevención Primaria/economía , Prevención Secundaria/economía , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos/efectos adversos , Neoplasias de la Mama/economía , Neoplasias de la Mama/mortalidad , Análisis Costo-Beneficio , Toma de Decisiones , Técnicas de Apoyo para la Decisión , Femenino , Fiebre/inducido químicamente , Fiebre/economía , Fiebre/prevención & control , Filgrastim , Factor Estimulante de Colonias de Granulocitos/uso terapéutico , Costos de la Atención en Salud , Humanos , Persona de Mediana Edad , Neutropenia/inducido químicamente , Neutropenia/economía , Neutropenia/mortalidad , Polietilenglicoles , Probabilidad , Años de Vida Ajustados por Calidad de Vida , Proteínas Recombinantes , Riesgo , Medición de Riesgo , Factores de Riesgo , Conducta de Reducción del Riesgo , Estados UnidosRESUMEN
Recent advances now permit resection of many pharyngeal tumors through the open mouth, an approach that can greatly reduce the morbidity of surgical exposure. These transoral techniques are being rapidly adopted by the surgical community and hold considerable promise. On November 6-7, 2011, the National Cancer Institute sponsored a Clinical Trials Planning Meeting to address how to further investigate the use of transoral surgery, both in the good prognosis human papillomavirus (HPV)-initiated oropharyngeal cancers, and in those with HPV-unrelated disease. The proceedings of this meeting are summarized.