Cost-Effectiveness Analysis Of Pegfilgrastim In Patients With Non-Small Cell Lung Cancer Receiving Ramucirumab Plus Docetaxel In Japan

Abstract Purpose: The dose-limiting factor of ramucirumab plus docetaxel (RAM+DTX) therapy in patients with non-small cell lung cancer (NSCLC) is febrile neutropenia (FN), which has a higher incidence in Asians. Pegfilgrastim (Peg-G) is routinely used for FN prophylaxis in Japan. This study aimed to evaluate the cost-effectiveness of Peg-G in patients with NSCLC receiving RAM+DTX in Japan.Methods: We simulated model patients treated with RAM+DTX in Japan and developed a decision-analytical model for patients receiving Peg-G prophylaxis or no primary prophylaxis. The expected cost, quality-adjusted life-year (QALY), and incremental cost-effectiveness ratio (ICER) of each treatment were calculated from the perspective of a Japanese healthcare payer. The willingness-to-pay (WTP) threshold was set at 45,867 United States dollars (USD) (5 million Japanese yen) per QALY gained. The probabilities, utility values, and other costs were obtained from published sources. Deterministic sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA) were conducted to evaluate the effect of each parameter on the results and robustness of the base-case results.Results: The expected cost and QALYs gained were 4,394 USD and 0.603 for Peg-G prophylaxis, and 2,242 USD and 0.578 for no primary prophylaxis, respectively. The ICER was calculated to be 83,147 USD per QALY gained. The results of DSA were most sensitive to FN risk with Peg-G. PSA revealed a 23.7% probability that primary prophylaxis with Peg-G was cost-effective. Conclusion: Peg-G is not cost-effective in patients with NSCLC receiving RAM+DTX in Japan.