Utility Analysis for Pegfilgrastim in DLBCL Patients on R-CHOP Regimen

항암치료를 받는 미만성거대비세포 림프종 환자에서 페그필그라스팀에 대한 효용성 평가

  • Jung, Hee Won (Graduate School of Clinical Pharmacy, Sookmyung Women's University) ;
  • Kim, Jeong Mee (Department of Pharmacy, Samsung Medical Center) ;
  • Min, Myung Sook (Department of Pharmacy, Samsung Medical Center) ;
  • Lee, Young Mee (Department of Pharmacy, Samsung Medical Center) ;
  • Bang, Joon Seok (Graduate School of Clinical Pharmacy, Sookmyung Women's University)
  • 정희원 (숙명여자대학교 임상약학대학원) ;
  • 김정미 (삼성서울병원 약제부) ;
  • 민명숙 (삼성서울병원 약제부) ;
  • 이영미 (삼성서울병원 약제부) ;
  • 방준석 (숙명여자대학교 임상약학대학원)
  • Received : 2015.07.17
  • Accepted : 2015.09.02
  • Published : 2015.09.30

Abstract

Objective: This study was designed to compare pegfilgrastim and filgrastim in diffuse large B-cell lymphoma (DLBCL) patients treated with a rituximab with cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisone (R-CHOP) regimen in terms of clinical efficacy and cost-effectiveness. Method: Clinical efficacy was measured by trough level of absolute neutrophil count (ANC), days of ANC under 50% of baseline value, days of ANC under 90% of baseline value, duration of ANC recovery to baseline value, days of ANC less than $0.5{\times}10^9cells/L$, and difference of peak and trough level of ANC during 1 cycle of R-CHOP regimen. To evaluate cost-effectiveness, total prices of used filgrastim and pegfilgrastim within 1 cycle of R-CHOP were analyzed. Results: In terms of clinical efficacy, trough level of ANC and days to ANC recovery showed statistical significance. The median trough levels of ANC with administration of filgrastim and pegfilgrastim were 0.18 and 1.94 (p = 0.021), respectively, and the median durations of ANC recovery to baseline value were 5.5 days and 2 days (p = 0.023), respectively. For the median days of ANC under 50% of baseline value, days of ANC under 90% of baseline value, days of ANC less than $0.5{\times}10^9cells/L$, and difference of peak and trough level of ANC during 1 cycle of R-CHOP, the pegfilgrastim group performed better than the filgrastim group. However the difference was not statistically significant. In terms of overall expense during 1 cycle of R-CHOP, pegfilgrastim is about 3.43 times more expensive than filgrastim. Conclusion: Pegfilgrastim is more efficient than filgrastim in terms of clinical efficacy. In terms of prices, pegfilgrastim is more expensive than filgrastim for patients, but it is more convenient in clinical use. Therefore, pegfilgrastim should be the preferred choice of G-CSF for neutropenic patients. Further comparative study of pegfilgrastim and filgrastim is needed.

Keywords

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