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Cost-Effectiveness of Primary Prophylaxis With G-CSF Biosimilars in Patients at Risk of Febrile Neutropenia
Real-world data indicate that the long-acting pegfilgrastim (PEG) may be superior to short-acting filgrastim (FIL) for reducing the incidence of febrile neutropenia (FN) caused by chemotherapy. To assess the cost-effectiveness of primary prevention of FN with PEG vs with FIL in patients with cancer who are at high risk of FN, researchers developed a Markov model with a lifetime horizon and used real-world data (Future Oncol. 2022;18(16):1979-1996. doi:10.2217/fon-2022-0095).
“FN reduces cancer patient survival rates through delays, dose reductions, and discontinuations of chemotherapy schedules,” wrote Jingyan Yang, Dr PH, MHS, Institute for Social and Economic Research and Policy, Columbia University, New York, NY, and colleagues, adding, “Analogs of G-CSFs [granulocyte-colony stimulating factors] such as FIL have proven effective in reducing FN incidence and are recommended for the prevention of chemotherapy-induced neutropenia in international guidelines.”
“[I]n real-world studies PEG proved to be a more effective formulation compared with short-acting G-CSF, resulting in reduced hospitalization and fewer chemotherapy dose delays, which might be explained by the underdosing of short-acting G-CSFs in routine clinical practice,” the researchers wrote.
“The benefits of PEG have not been fully unleashed due to its higher costs compared with FIL; however, in the past few years, accelerated adoption of PEG has been observed due to the availability of PEG biosimilars,” stated researchers, adding, “To the best of our knowledge, no economic evaluations have been conducted to compare FIL and PEG using real-world effectiveness data while taking biosimilars into consideration.”
To conduct such an evaluation, Dr Yang and team developed an economic model by using Microsoft Excel to analyze the cost-effectiveness of primary prevention of FN with PEG vs FIL from a US payer perspective. Their analysis incorporated two patient populations given myelosuppressive anticancer drugs with a clinically significant incidence of FN. One population was at high risk of FN (>20%), and the other was at intermediate risk of FN (10% to 20%). The researchers adopted a lifetime horizon, which was assumed to be 40 years based on a mean age of 60 years in patients who receive G‑CSFs in clinical practice.
For each patient population, the researchers analyzed the cost-effectiveness of 5 prevention strategies, each using one of the following G-CSFs: PEG biosimilars, the PEG reference product in a pre-filled syringe; the PEG reference product in an on-body injector; FIL biosimilars; and the FIL reference product. They discounted clinical and economic outcomes by 3% annually.
Using these methods, the researchers found that, for the high-risk group, compared with using the FIL biosimilar, using the PEG biosimilar prevented 0.43 FN event, gained 0.27 quality-adjusted life-year (QALY), and saved $5703.
For the intermediate-risk group, compared with using the FIL biosimilar, using the PEG biosimilar prevented 0.18 FN event and gained 0.12 QALY, for an additional cost of $1752. Thus, the cost per FN avoided was $9674, and the cost per QALY gained was $14,502.
“[PEG] biosimilars have the potential to financially optimize neutropenia management in cancer patients by reducing FN incidence and FN-related healthcare resource utilization, and to potentially improve health outcomes,” the researchers concluded, adding, “Extending primary prophylaxis with PEG biosimilars from cancer patients with high to intermediate risk of FN resulted in clinical benefits, at acceptable incremental costs.”
