G-CSF FOR THE PROPHYLAXIS OF NEUTROPENIC FEVER IN PATIENTS WITH SMALL-CELL LUNG-CANCER RECEIVING MYELOSUPPRESSIVE ANTINEOPLASTIC CHEMOTHERAPY - METAANALYSIS AND PHARMACOECONOMIC EVALUATION

Standard meta-analytical and pharmacoeconomic techniques were used to study the clinical effectiveness and the cost-effectiveness ratio of t he prophylactic (or pre-emptive) administration of G-CSF to patients w ith small cell lung cancer treated with conventional myelosuppressive cytotoxic chemotherapy. In the first part of our study, we conducted a meta-analysis of the randomized clinical trials evaluating G-CSF for this clinical indication. Three trials were identified by our literatu re search and were included in the metaanalysis (overall number of pat ients = 606). The end-points for evaluating G-CSF included mortality f rom infection and the cumulative incidence of neutropenic fever over s ix cycles of chemotherapy. The results of our meta-analysis demonstrat e that prophylactic G-CSF did not affect mortality but significantly r educed the incidence of neutropenic fever from 68.3% to 38.7% (pooled odds ratio = 0.29, 95% CI: 0.21-0.40; P < 0.001). In the second part o f our study, we carried out a pharmacoeconomic analysis to estimate th e cost-effectiveness ratio of pre-emptive G-CSF (i.e. the 'average' co st associated with the prevention of an episode of neutropenic fever). This cost-effectiveness ratio was US$ 14 372 using the Italian price of the drug converted into dollars, or US$ 41 088 using the US price. Finally, we estimated the revenue-neutral price of G-CSF based on Amer ican data of the cost-of-illness. This price ranged from US$ 395 to US $ 569 per cycle, a figure higher than the value (US$ 150) previously r eported in the literature.