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Abstract：
OBJECTIVE: To examine the cost-effectiveness of using granulocyte colony-stimulating factor (G-CSF) for primary or secondary prophylaxis in patients with breast cancer from the perspective of Taiwan\'s National Health Insurance Administration.
METHODS: A Markov model was constructed to simulate the events that may occur during and after a high-risk chemotherapy treatment. Various G-CSF prophylaxis strategies and medications were compared in the model. Effectiveness data were derived from the literature and an analysis of the National Health Insurance Research Database (NHIRD). Cost data were obtained from a published NHIRD study, and health utility values were also obtained from the literature. Sensitivity analyses were performed to assess the uncertainty of the cost-effectiveness results.
RESULTS: In the base-case analysis, primary prophylaxis with pegfilgrastim had an incremental cost-effectiveness ratio (ICER) of NT$269,683 per quality-adjusted life year (QALY) gained compared to primary prophylaxis with lenograstim. The ICER for primary prophylaxis with lenograstim versus no G-CSF prophylaxis was NT$61,995 per QALY gained. The results were most sensitive to variations in relative risk of febrile neutropenia (FN) for pegfilgrastim versus no G-CSF prophylaxis. Furthermore, in the probabilistic sensitivity analysis, at a willingness-to-pay threshold of one times Taiwan\'s gross domestic product per capita, the probability of being cost-effective was 88.1% for primary prophylaxis with pegfilgrastim.
CONCLUSIONS: Our study suggests that primary prophylaxis with either short- or long-acting G-CSF could be considered cost-effective for FN prevention in breast cancer patients receiving high-risk regimens.
METHODS: A Markov model was constructed to simulate the events that may occur during and after a high-risk chemotherapy treatment. Various G-CSF prophylaxis strategies and medications were compared in the model. Effectiveness data were derived from the literature and an analysis of the National Health Insurance Research Database (NHIRD). Cost data were obtained from a published NHIRD study, and health utility values were also obtained from the literature. Sensitivity analyses were performed to assess the uncertainty of the cost-effectiveness results.
RESULTS: In the base-case analysis, primary prophylaxis with pegfilgrastim had an incremental cost-effectiveness ratio (ICER) of NT$269,683 per quality-adjusted life year (QALY) gained compared to primary prophylaxis with lenograstim. The ICER for primary prophylaxis with lenograstim versus no G-CSF prophylaxis was NT$61,995 per QALY gained. The results were most sensitive to variations in relative risk of febrile neutropenia (FN) for pegfilgrastim versus no G-CSF prophylaxis. Furthermore, in the probabilistic sensitivity analysis, at a willingness-to-pay threshold of one times Taiwan\'s gross domestic product per capita, the probability of being cost-effective was 88.1% for primary prophylaxis with pegfilgrastim.
CONCLUSIONS: Our study suggests that primary prophylaxis with either short- or long-acting G-CSF could be considered cost-effective for FN prevention in breast cancer patients receiving high-risk regimens.
摘要：
目的：从台湾国家医疗保险管理局的角度，研究粒细胞集落刺激因子（G-CSF）用于乳腺癌患者的一级或二级预防的成本效益。
方法：构建了马尔可夫模型，以模拟高风险化疗治疗期间和之后可能发生的事件。在模型中比较了各种G-CSF预防策略和药物。有效性数据来自文献和国家健康保险研究数据库（NHIRD）的分析。成本数据来自一项已发表的NHIRD研究，和健康效用值也从文献中获得。进行了敏感性分析，以评估成本效益结果的不确定性。
结果：在基本案例分析中，与使用来诺格司汀的初级预防相比,使用pegfilgrastim的初级预防每质量调整生命年(QALY)增加的成本-效果比(ICER)为新台币269,683元.来诺格司亭一级预防与无G-CSF预防的ICER为每增加QALYNT$61,995。结果对pegfilgrastim与无G-CSF预防相比，发热性中性粒细胞减少症（FN）的相对风险变化最敏感。此外，在概率敏感性分析中，在台湾人均国内生产总值一倍的支付意愿门槛下，使用pegfilgrastim进行初级预防的成本效益概率为88.1%.
结论：我们的研究表明，在接受高风险方案的乳腺癌患者中，短效或长效G-CSF的一级预防可被认为是预防FN的成本有效的。
方法：构建了马尔可夫模型，以模拟高风险化疗治疗期间和之后可能发生的事件。在模型中比较了各种G-CSF预防策略和药物。有效性数据来自文献和国家健康保险研究数据库（NHIRD）的分析。成本数据来自一项已发表的NHIRD研究，和健康效用值也从文献中获得。进行了敏感性分析，以评估成本效益结果的不确定性。
结果：在基本案例分析中，与使用来诺格司汀的初级预防相比,使用pegfilgrastim的初级预防每质量调整生命年(QALY)增加的成本-效果比(ICER)为新台币269,683元.来诺格司亭一级预防与无G-CSF预防的ICER为每增加QALYNT$61,995。结果对pegfilgrastim与无G-CSF预防相比，发热性中性粒细胞减少症（FN）的相对风险变化最敏感。此外，在概率敏感性分析中，在台湾人均国内生产总值一倍的支付意愿门槛下，使用pegfilgrastim进行初级预防的成本效益概率为88.1%.
结论：我们的研究表明，在接受高风险方案的乳腺癌患者中，短效或长效G-CSF的一级预防可被认为是预防FN的成本有效的。
