Cost‐effectiveness of granulocyte colony‐stimulating factor prophylaxis in chemotherapy‐induced febrile neutropenia among breast cancer and Non‐Hodgkin's lymphoma patients under Taiwan's national health insurance system

2016 ◽  
Vol 23 (2) ◽  
pp. 288-293 ◽  
Author(s):  
Tsun‐Jen Wen ◽  
Yu‐Wen Wen ◽  
Chun‐Ru Chien ◽  
Shao‐Chin Chiang ◽  
William Wei‐Yuan Hsu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Insurance ◽  
Cost Effectiveness ◽  
Febrile Neutropenia ◽  
National Health Insurance ◽  
Granulocyte Colony Stimulating Factor ◽  
Colony Stimulating Factor ◽  
Health Insurance System ◽  
National Health Insurance System ◽  
Stimulating Factor

Modeling the cost-effectiveness of granulocyte colony-stimulating factor use in early-stage breast cancer.

1998 ◽  
Vol 16 (7) ◽  
pp. 2435-2444 ◽  
Author(s):  
J H Silber ◽  
M Fridman ◽  
A Shpilsky ◽  
O Even-Shoshan ◽  
D S Smink ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Response Curve ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Granulocyte Colony Stimulating Factor ◽  
Colony Stimulating Factor ◽  
Breast Cancer Patients ◽  
The Cost ◽  
Stimulating Factor

PURPOSE To model the cost-effectiveness (CE) of granulocyte colony-stimulating factor (G-CSF) in early-stage breast cancer when its use is directed to those most in need of the medication. METHODS A conditional CE model was developed for the use of G-CSF based on a ranking of patient need as determined by patient blood counts during the first cycle of chemotherapy. In the base case, no G-CSF was used. In the alternative case, G-CSF was used in the following manner. If the risk of a neutropenic event (as defined by a predictive model based on nadir absolute neutrophil count [ANC] and hemoglobin decrease in cycle 1) was equal to or exceeded a predetermined critical value "T," then patients would receive G-CSF in cycles 2 through 6 of chemotherapy. If the risk of an event was less than T, patients would not use G-CSF unless an event occurred, at which time G-CSF would be administered with every subsequent cycle. RESULTS A decision rule (T) that would allow the most needy 50% of early-stage breast cancer patients to receive G-CSF after the first cycle of chemotherapy resulted in a CE ratio of $34,297 dollars per life-year saved (LYS). If only the most needy 10% of patients received G-CSF, then the associated CE ratio was $23,748/LYS; if 90% of patients could receive the medication, the CE ratio would be $76,487/LYS. These estimates were relatively insensitive to inpatient hospital cost estimates (inpatient costs for fever and neutropenia of $3,090 to $7,726 per admission produced dollar per LYS figures of $34,297 to $32,415, respectively). However, the model was sensitive to assumptions about the shape of the relationship between dose reduction and disease-free survival (DFS) at 3 years. CONCLUSION Providing G-CSF to the neediest 50% of early-stage breast cancer patients (as defined by first-cycle blood counts) starting after the first cycle of chemotherapy is associated with a CE ratio of $34,297/LYS, which is well in the range of CE ratios for treatment of other common medical conditions. Furthermore, conditional CE studies, based on predictive models that incorporate individual patient risk, allow one to define populations for which therapy is, or is not, cost-effective. Limitations of our present understanding of the shape of the chemotherapy dose-response curve, especially at low levels of dose reductions, affect these results. Further work is required to define the shape of the dose-response curve in early-stage breast cancer.

scholarly journals Granulocyte Colony Stimulating Factor (G-CSF) Induced Splenic Infarction in Breast Cancer Patient Treated with Dose-Dense Chemotherapy Regimen

2019 ◽  
Vol 2019 ◽  
pp. 1-4 ◽  
Author(s):  
Majed A. Alshamrani ◽  
Meteb Al-Foheidi ◽  
Ahmed H. Abdulrahim
Keyword(s):  
Breast Cancer ◽  
Febrile Neutropenia ◽  
Splenic Infarction ◽  
Granulocyte Colony Stimulating Factor ◽  
Colony Stimulating Factor ◽  
Rare Side Effect ◽  
Splenic Biopsy ◽  
Dose Dense ◽  
Stimulating Factor ◽  
Factor G

Introduction. Granulocyte colony-stimulating factor (G-CSF) is commonly used for prevention and treatment of febrile neutropenia among solid tumor patients. It is considered an effective and relatively safe supportive care medication; however, it can cause rare and serious side effects such as spleen rupture or infarction. Case Presentation. We are reporting a case of a 27-year-old female with breast cancer who has been treated with dose-dense chemotherapy and received colony-stimulating factor as primary prevention of febrile neutropenia that was complicated halfway through with splenic infarction. This finding was confirmed by computed tomography (CT) scan and splenic biopsy. Management was conservative without the need of surgical intervention. Conclusion. Although splenic infarction is an extremely rare side effect of G-CSF, it can be a serious complication that should be recognized, monitored, and managed carefully.

scholarly journals Cost-Effectiveness of Contraceptive Use in Indonesia after the Implementation of the National Health Insurance System

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Auliya A. Suwantika ◽  
Neily Zakiyah ◽  
Irma M. Puspitasari ◽  
Rizky Abdulah
Keyword(s):  
Health Insurance ◽  
Cost Effectiveness ◽  
National Health Insurance ◽  
National Health ◽  
Contraceptive Use ◽  
Intrauterine Device ◽  
Health Insurance System ◽  
National Health Insurance System ◽  
Insurance System ◽  
The Cost

Since 2014, Indonesia has initiated to implement a national health insurance system, which included both of short- (SARC) and long-acting reversible contraceptive (LARC) into the benefit package. The aim of this study was to analyze the cost-effectiveness of contraceptive use in Indonesia after the implementation of the national health insurance in 2014-2017. A decision tree model was developed to analyze the cost-effectiveness of contraceptive use in Indonesia in 2014-2017 by comparing two strategies of pregnancy prevention: contraceptive and non-contraceptive. For contraceptive strategy, we took into account SARC and LARC. In a comparison with non-contraceptive, we calculated that the incremental cost-effectiveness ratio (ICER) of SARC would be $5.18, $4.80 and $3.76 per pregnancy averted for injection, condom, and pill, respectively. For LARC, we calculated that the ICER would be $1.67 and $0.84 for implant and intrauterine device (IUD), respectively, compared with non-contraceptive. In general, the cost-effectiveness value of LARC ($1.25) was much better than SARC ($4.58). The cost of contraceptive was considered to be the most influential parameter affecting both the ICER of SARC and LARC. In conclusion, the use of LARC in Indonesia was considered to be more cost-effective than SARC since the implementation of national health insurance system. In particular, IUD yielded the greatest cost-effectiveness value, compared with other methods.

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