医療薬学
Online ISSN : 1882-1499
Print ISSN : 1346-342X
ISSN-L : 1346-342X
一般論文
非ホジキンリンパ腫患者に対するCHOP療法に伴う発熱性好中球減少症の1次予防におけるペグフィルグラスチムの費用対効果
杉本 智哉近藤 有一木 万奈美荒川 裕貴間瀬 広樹牛膓 沙織佐久間 昌基小山 佐知子大島 有美子宮崎 雅之築山 郁人佐藤 由美子久田 達也板倉 由縁山田 清文
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2018 年 44 巻 9 号 p. 441-448

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The objective of this study was to evaluate the cost-effectiveness of pegfilgrastim (Peg-G) and daily filgrastim (Fil-G) for the primary prophylaxis against febrile neutropenia (FN) in patients with non-Hodgkin lymphoma (NHL) who received cyclophosphamide, vincristine, doxorubicin and prednisolone (CHOP) therapy. We developed a decision analytical model reflecting the clinical processes of NHL patients who received first CHOP therapy. The probabilities at each clinical endpoint were obtained from published sources. To estimate the costs and duration of FN treatment, we analyzed the medical records of NHL patients in hospitals participating in this study. The costs of Peg-G and Fil-G were calculated according to the National Health Insurance drug price list. We assessed an incremental cost-effectiveness ratio (ICER) for a single dose of Peg-G versus 11-days of Fil-G from the perspective of health insurance payers. The sensitivity and robustness of this model were validated by the tornado-diagram and Monte Carlo Method. The costs associated with primary prophylaxis with a single dose of Peg-G and 11-days of Fil-G were 109,628 JPY and 109,243 JPY, respectively. The quality adjusted life years (QALYs) associated with the two strategies were 0.0339 QALYs and 0.0337 QALYs, respectively. The ICER for the Peg-G versus Fil-G was 2,788,571 JPY per QALY. The tornado-diagram revealed that the main influential factors included the cost of Peg-G, number of Fil-G doses, and cost of Fil-G. Monte Carlo simulation revealed an 18.3% probability that Peg-G was cost-effective compared with Fil-G. A single dose of Peg-G was cost-effective compared with 11-days of Fil-G.

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