Table A31One-way sensitivity analyses results for solid tumour patients who can take quinolone: Nothing/ placebo v.s Primary prophylaxis with G(M)-CSF

AnalysisValueIncremental costs (£)Incremental QALYsICER (£) incremental
(QALYs)		Optimal strategyProbability CE 1
SA1: Number of cycles of chemotherapy1£771.54.7*10-4£1.6 millionNothing/placebo100%
6£4,733.98.7*10-4£5.5 millionNothing/placebo100%
SA2: Baseline risk of neutropenic sepsis per chemotherapy cycle: Cycle 2 onwards 25%£2,399.67.4*10-4£3.2 millionNothing/placebo100%
100%£1,884.61.5*10-3£1.3 millionNothing/placebo100%
SA3: Relative risk of a neutropenic sepsis episode: Cycle 1 versus Cycle 2 onwards1£2,399.17.1*10-4£3.4 millionNothing/placebo100%
10£2,374.88.7*10-4£2.7 millionNothing/placebo100%
SA4: Relative risk of a neutropenic sepsis episode: Previous neutropenic sepsis versus no previous neutropenic sepsis1£2,442.96.1*10-4£4.0 millionNothing/placebo100%
10£2,296.91.1*10-3£2.1millionNothing/placebo100%
SA5: Relative risk of a neutropenic sepsis episode: G(M)-CSF versus nothing/placebo0.1£2,141.12.1*10-3£1.0 millionNothing/placebo100%
0.95£2,459.32.6*10-4£9.6 millionNothing/placebo100%
SA6: Probability of self administrating G(M)-CSF0%£2,598.39.2*10-4£2.8 millionNothing/placebo100%
100%£2,107.59.2*10-4£2.3 millionNothing/placebo100%
SA7: Probability of using an ambulance for patients with neutropenic sepsis0£2,377.59.2*10-4£2.6 millionNothing/placebo100%
100%£2,321.39.2*10-4£2.5 millionNothing/placebo100%
SA8: Probability of patients with neutropenic sepsis who are at high risk of serious adverse events5%£3,377.98.3*10-4£2.9 millionNothing/placebo100%
20%£2,303.01.1*10-3£2.1 millionNothing/placebo100%
SA9: Days of using G(M)-CSF for each cycle of chemotherapy5 d£1,397.09.2*10-4£1.5 millionNothing/placebo100%
11 d£3,308.99.2*10-4£3.6millionNothing/placebo100%
SA10: Days of inpatient treatment for neutropenic sepsis patients at low-risk of serious adverse events1£2,405.37.0*10-4£3.4 millionNothing/placebo100%
6£2,143.31.8*10-3£1.2 millionNothing/placebo100%
SA11: Days of inpatient treatment for neutropenic sepsis patients at high-risk of serious adverse events6£2,358.78.9*10-4£2.6 millionNothing/placebo100%
14£2,312.21.1*10-3£2.1 millionNothing/placebo100%
SA12: Cost per hospital bed day£100£2,454.49.2*10-4£2.7 millionNothing/placebo100%
£1000£1,865.39.2*10-4£2.0 millionNothing/placebo100%
SA13: Daily cost of G(M)-CSF per person£60.69 3£1,467.69.2*10-4£1.6 millionNothing/placebo100%
£98.57 4£2,352.99.2*10-4£2.6 millionNothing/placebo100%
SA14: Drug discounts of G(M)-CSF0% 5£3,352.99.2*10-4£2.6 millionNothing/placebo100%
90% 6£279.59.2*10-4£0.3 millionNothing/placebo100%
SA15: Utility decrement due to inpatient treatment of neutropenic sepsis)0.14£2,352.94.9*10-4£4.8 millionNothing/placebo100%
0.38£2,352.99.2*10-4£2.6 millionNothing/placebo100%
SA16: Utility decrement due to outpatient treatment of neutropenic sepsis0£2,352.96.8*10-4£3.5 millionNothing/placebo100%
0.15£2,352.99.3*10-4£2.5 millionNothing/placebo100%
1

CE = cost effective at a NICE WTP threshold of £20,000/QALY.

2

In the economic analysis, it is assumed that the relative risk of a neutropenic sepsis event in the first cycle of chemotherapy compared with cycle two onwards is 3.69 (Cullen, 2007). Therefore by testing a range of 5-100% risk of neutropenic sepsis (per cycle) for Cycle 2 onwards; we tested a range of 1.4-100% risk of neutropenic sepsis (per cycle) for the first cycle of chemotherapy.

3

Average cost of filgrastim and lenograstim assuming the daily dose of G(M)-CSF is 30 million-units for all adult patients regardless of weight.

4

Calculated from filgrastim and lenograstim based on patient weight distribution reported by: Green 2003, Romieu 2007 and Gigg 2003 (see appendix A10).

5

Corresponding price of G(M)-CSF (when 0% discount is used):

  • Filgrastim (30 million-unit syringe): £58.84.
  • Filgrastim (48 million-unit syringe): £93.93.
  • Lenograstim (13.4 million-unit syringe): £31.39.
  • Lenograstim (33.6 million-unit syringe): £62.54.

6

Corresponding price of G(M)-CSF (when 90% discount is used):

  • Filgrastim (30 million-unit syringe): £5.9.
  • Filgrastim (48 million-unit syringe): £9.4.
  • Lenograstim (13.4 million-unit syringe): £3.1.
  • Lenograstim (33.6 million-unit syringe): £6.3.

From: Appendix A, A cost-utility analysis of primary and secondary prophylaxis with G(M)-CSF and/or quinolones for the prevention of neutropenic sepsis

Cover of Neutropenic Sepsis: Prevention and Management of Neutropenic Sepsis in Cancer Patients
Neutropenic Sepsis: Prevention and Management of Neutropenic Sepsis in Cancer Patients.
NICE Clinical Guidelines, No. 151.
National Collaborating Centre for Cancer (UK).
Copyright © National Collaborating Centre for Cancer, 2012.

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