Aims: To audit the cost effectiveness of primary versus secondary pegylated G-CSF treatment to prevent febrile neutropenia associated hospitalization amongst patients with early breast cancer.
Methods: An electronic data base search for all breast cancer patients treated at SCGH between 2014-2015 to extract patients admitted with febrile neutropenia using ‘breast cancer’, ‘febrile’ and ‘neutropenia’ codes was performed. Patient files were reviewed for data including the type and intent of chemotherapy, number of cycles, and severity of neutropenia represented by the duration of admission.
Results: Between 2014-2015, 202 patients with breast cancer were treated with chemotherapy. 28 were excluded for causes including patients with de novo-metastatic disease, those who received chemotherapy for a concurrent malignancy, or received primary or secondary pegylated G-CSF prophylaxis for reasons other than febrile neutropenia. Overall, 28/174 (16.1%) patients developed febrile neutropenia. 11.1% (10/90) of patients who received sequential taxane and anthracycline chemotherapy developed febrile neutropenia mainly due to taxane administration in FEC-D. Significantly, 22.6% (12/53) of patients received TC or TCH developed febrile neutropenia. Patients who received paclitaxel only did not develop febrile neutropenia. 46% of febrile neutropenia occurred after cycle 1, with the median length of hospitalization being 5.5 (2-12) days. No patient required ICU admission. Considering the cost of hospitalization to commence at $1200/night and the price of each Pegylated G-CSF injection to be $1300, then the total estimated cost for secondary prophylaxis in our patient cohort plus the cost of hospitalization was $281,660. Conversely, the cost associated with primary administration of pegylated G-CSF from cycle one for the same cohort of patients, assuming that none of them developed febrile neutropenia after G-CSF prophylaxis, would be $1,291,900.
Conclusions: Amongst our cohort of early breast cancer patients, primary prophylaxis against febrile neutropenia with pegylated G-CSF would not be a cost-effective strategy.