Adi Eldar-Lissai

Economic Analysis of Prophylactic Pegfilgrastim in Adult Cancer Patients Receiving Chemotherapy

OBJECTIVES Neutropenia and its complications, including febrile neutropenia (FN), are a common side effect of cancer chemotherapy. Results of clinical trials showed that prophylactic use of granulocyte colony-stimulating factors (G-CSF) is effective in preventing FN. In this study, the cost effectiveness (measured as cost per quality-adjusted time [days]) of three treatment alternatives were evaluated: no G-CSF, filgrastim administered daily for 7-12 days after chemotherapy, and a pegylated form of G-CSF pegfilgrastim, administered once per cycle. METHODS A cost-utility model based on standard clinical practice of treating FN with immediate hospitalization or with ambulatory treatment, from a societal perspective was developed. Direct medical cost estimates for hospitalization were derived from claims data reported by 115 US academic medical centers. Indirect medical costs, productivity costs, probabilities, and utilities are based on published literature. Results were subjected to sensitivity analyses and 95% confidence intervals are based on a Monte Carlo simulation. RESULTS Mean estimated costs/day of hospitalization were

Therapeutic Use of Granulocyte Colony-Stimulating Factors for Established Febrile Neutropenia: Effect on Costs from a Hospital Perspective

1984 (SD

Resource utilization and costs following hospitalization of patients with chronic heart failure in the US

1040, N = 24,687) for surviving patients and

Is Addition of Vasodilators to Loop Diuretics of Value in the Care of Hospitalized Acute Heart Failure Patients? Real-World Evidence From a Retrospective Analysis of a Large United States Hospital Database

3139 (SD

Interprofessional education about decision support for patients across cultures

2014, N = 1437) for dying patients. Under baseline conditions, pegfilgrastim dominated both filgrastim and no G-CSF, with expected costs and effectiveness of

The economics of the hematopoietic growth factors.

4203 and 12.361 quality adjusted life-days (QALDs) for no G-CSF,

Response to comment on "is addition of vasodilators to loop diuretics of value in the care of hospitalized acute heart failure patients? Real-world evidence from a retrospective analysis of a large United States hospital database".

3058 and 12.967 QALDs for pegfilgrastim, and

Treating acute heart failure in the elderly: A comparison of three inpatient treatment alternatives in the United States

5264 and 12.698 QALDs for filgrastim. CONCLUSIONS This cost-utility analysis provides strong evidence that pegfilgrastim is not only cost-effective but also cost-saving in most common clinical and economic settings. There appear to be both clinical and economic benefits from prophylactic administration of pegfilgrastim.

PCV14 Are Vasodilators of Value in the Care of Patients Hospitalized for Acute Heart Failure

BackgroundThe prophylactic use of granulocyte colony-stimulating factors (G-CSFs) reduces the severity and duration of neutropenia and reduces the incidence of febrile neutropenia after cancer chemotherapy. However, the use of G-CSFs, particularly filgrastim, to treat established neutropenia remains controversial. A recent meta-analysis of randomised controlled trials (RCTs) evaluating G-CSF treatment for established febrile neutropenia demonstrated a reduction in prolonged hospitalisations. Because more than one-third of patients in the analysis were hospitalised for at least 10 days, this finding has broad pharmacoeconomic and clinical significance. This analysis presents the potential cost implications of G-CSF treatment for established neutropenia among hospitalised patients.MethodsDirect medical costs (

PCV102 Chronic Heart Failure in the Elderly: Costs and Resource Utilization Following Initial Hospitalizaton

US, year 2003 values) related to hospitalisation for established neutropenia were modelled using a hospital perspective and according to two treatment options: (i) no use of G-CSF during the neutropenic episode (control); and (ii) addition of daily G-CSF until neutrophil recovery. Within each option, we modelled the probability of a long stay (≥10 days) and patient survival. The model used three data sets: discharge data from a consortium of academic medical institutions, drug cost data (filgrastim) from Federal payers, and estimates of G-CSF efficacy derived from a meta-analysis of RCTs of treatment in patients with established febrile neutropenia. The lowest expected total cost was predicted for both treatment options; sensitivity analyses and Monte Carlo simulations were used to evaluate the robustness of the model.ResultsThe G-CSF arm produced the lowest expected cost, and predicted net estimated savings of