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In this issue of the Journal, Lathia et al. ( 1 ) modeled the cost-effectiveness of primary prophylaxis with filgrastim or pegfilgrastim against febrile neutropenia in patients with diffuse large B-cell lymphoma (DLBCL) undergoing chemotherapy from the perspective of a publicly funded health-care system. The inputs for the model were obtained from published literature and clinical practice. The model indicated that in the base case analysis, costs (in 2012 Canadian dollars) associated with no primary prophylaxis, or primary prophylaxis with 10 days of filgrastim, or a single dose of pegfilgrastim per cycle were $7314, $13497, and $16290, respectively. The incremental cost-effectiveness ratios for filgrastim vs no primary prophylaxis was $5.8 million per quality-adjusted life year (QALY) and for pegfilgrastim vs filgastrim primary prophylaxis was $2.6 million per QALY. In comparison with no prophylaxis, there was a slight increase in QALYs with filgastrim (0.2015 vs 0.2004) and pegfilgrastim (0.2024 vs 0.2004). However, this model was based on the important assumption (in accordance with current evidence) that the primary benefit of granulocyte colony-stimulating factor is in preventing chemotherapy-induced neutropenia and that there is no survival benefit associated with use of these drugs in persons with DLBCL ( 2–5 ). These results are in sharp contrast to a previously reported analysis in lymphoma patients where pegfilgrastim prophylaxis was associated with an incremental cost-effectiveness ratio of $6190 per QALY when a febrile neutropenia–related mortality benefit was assumed and $1677 per QALY when a long-term mortality benefit was assumed ( 6 ). On the other hand, a model of the cost-effectiveness of filgrastim, using a death state in the model and not including a mortality benefit found an incremental cost-effectiveness ratio of $700000 per QALY. This estimate, similar to the estimates of Lathia et al. ( 1 ), is consistent with a conclusion that filgrastim is not cost-effective ( 7 ).

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