Cost-Effectiveness of Primary Prophylaxis With Biosimilar Filgrastim for Patients at Risk for Febrile Neutropenia

Study findings reveal primary prophylaxis with biosimilar filgrastim-sndz is cost-effective in patients at intermediate risk for febrile neutropenia receiving curative chemotherapy for breast cancer, non-small cell lung cancer (NSCLC), and non-Hodgkin lymphoma (NHL; JCO Oncol Pract. 2021;17[8]:e1235-e1245. doi:10.1200/OP.20.01047).

“Temporary COVID-19 guideline recommendations have recently been issued to expand the use of colony-stimulating factors in patients with cancer with intermediate to high risk for febrile neutropenia,” wrote Edward Li, PharmD, MPH, Sandoz, Inc, Princeton, NJ, and colleagues.

“Considering these new recommendations during the pandemic and the general trend toward value-based care in oncology, we compared the different [colony-stimulating factor] prophylaxis strategies from a clinical and economic perspective,” they continued.

This study evaluated the cost-effectiveness of primary prophylaxis vs secondary prophylaxis with biosimilar filgrastim-sndz for patients with breast cancer, NSCLC, and NHL receiving curative chemotherapy.

Researchers developed a Markov decision analytic model from the US payer perspective over a lifetime horizon. Cost-effectiveness was evaluated over a range of willingness-to-pay (WTP) thresholds for incremental cost per febrile neutropenia avoided, life year gained, and quality-adjusted life year (QALY) gained.

Primary prophylaxis provided an additional 0.102-0/144 LYs and 0.065-0.130 QALYs compared to secondary prophylaxis. The incremental cost-effectiveness ranged from $5660 to $20,806 per febrile neutropenia event avoided; $5123 to $31,077 per life year gained; and $7213 to $35,563 per QALY gained.

Over 1000 iterations, there were 73.6%, 99.4%, and 91.8% probabilities that primary prophylaxis was cost-effective at a WTP threshold of $50,000 per QALY gained for breast cancer, NSCLC, and NHL, respectively.

“[Primary prophylaxis] with a biosimilar filgrastim (specifically filgrastim-sndz) is cost-effective in patients with intermediate risk for febrile neutropenia receiving curative chemotherapy regimens for breast cancer, NSCLC, and NHL,” concluded Dr Li and colleagues.

“Expanding the use of colony-stimulating factors for patients may be valuable in reducing unnecessary health care visits for patients with cancer at risk of complications because of COVID-19 and should be considered for the indefinite future,” they added.