ABSTRACT
INTRODUCTION: We evaluated the use of text messages to communicate information to patients whose surgeries were postponed because of the COVID-19 restriction on elective surgeries. Our hypothesis was that text messaging would be an effective way to convey updates. METHODS: In this observational study, 295 patients received text messaging alerts. Eligibility included patients who had their surgery postponed and had a cell phone that received text messages. Engagement rates were determined using embedded smart links. Patient survey responses were collected. RESULTS: A total of 3,032 texts were delivered. Engagement rates averaged 90%. Survey responses (n = 111) demonstrated that 98.2% of patients liked the text messages and 95.5% said that they felt more connected to their care team;91.9% of patients agreed that the text updates helped them avoid calling the office. Patients with higher pain levels reported more frustration with their surgery delay (5.3 versus 2.8 on 1 to 10 scale, P value < 0.01). More frustrated patients wished they received more text messages (24.4% versus 4.6%, P value = 0.04) and found the content less helpful (8.2 versus 9.2 on 1 to 10 scale, P value = 0.01). CONCLUSION: Text messaging updates are an efficient way to communicate with patients during the COVID-19 pandemic.
ABSTRACT
Background: According to clinical practice guidelines, the threshold for routine myeloid growth factor (MGF) PP is a high risk (>20%) of developing FN. However, in response to the COVID-19 pandemic, a recent recommendation expands this threshold for using MGF PP to include patients at intermediate risk (10-20%) of developing FN, with the goal of reducing emergency room and hospital visits. Patients with breast cancer receiving potentially curative chemotherapy consisting of docetaxel or paclitaxel (every 21 days) are at an intermediate risk (10-20%) of developing FN. This study evaluates the cost-effectiveness of PP vs. SP using a biosimilar MGF, filgrastim-sndz, in earlystage breast cancer patients at intermediate risk of FN. Methods: A Markov model with a lifetime horizon was constructed to evaluate the total costs and clinical outcomes when using filgrastim-sndz as PP vs. SP in 56 year old early-stage breast cancer patients receiving adjuvant docetaxel (following doxorubicin/cyclophosphamide) every 3 weeks for 4 cycles. Patients had ≥1 FN risk factor (i.e., recent surgery) without the receipt of anti-HER2 therapy, representing a 16% baseline FN risk. Average Sales Price (ASP) calculated from the Centers for Medicare & Medicaid Services July 2020 ASP Drug Pricing File was used as the filgrastim-sndz cost. Incremental cost-effectiveness ratios (ICERs) were calculated for cost per FN event avoided, life-year saved (LYS), and quality-adjusted life-year (QALY) gained from a United States payer perspective. Deterministic and probabilistic sensitivity analyses (PSA) were conducted. Results: Filgrastim-sndz as PP vs. SP provided an additional 0.102 FN events avoided, 0.065 LYS, and 0.056 QALYs at an incremental cost of $2,106. The ICERs were $20,656, $32,624 and $37,333 for cost per FN event avoided, cost per LYS, and cost per QALY gained, respectively. In the PSA, the likelihood of cost-effectiveness at a willingnessto-pay (WTP) threshold of $50,000 per QALY gained was 71.3%. Conclusions: For early-stage breast cancer patients at intermediate risk of FN receiving adjuvant docetaxel with 1 or more risk factors, PP with filgrastim-sndz compared to SP is cost-effective based on a WTP threshold of $50,000/QALY.