There are several options for the prophylaxis of febrile neutropenia (FN), including pegfilgrastim delivered in an on-body injector (OBI), a single injection of pegfilgrastim, and daily injections with reference filgrastim or Sandoz’ biosimilar filgrastim.
In a study presented at the American Society of Hematology’s annual meeting in San Diego, California that took place December 1-4, 2018, researchers presented results from a cost simulation study in patients with febrile neutropenia.
There are several options for the treatment of febrile neutropenia (FN) including a pegfilgrastim delivered in an on-body injector (OBI), a single injection of pegfilgrastim, and daily injections with reference filgrastim or Sandoz’ biosimilar filgrastim. However, failure rates of the OBI may increase the risk of chemotherapy-induced FN and FN-related hospitalizations beyond standard hospitalization rates for prophylaxis with pegfilgrastim and reference or biosimilar filgrastim. The study’s authors sought to estimate the total incremental costs of pegfilgrastim OBI FN prophylaxis and incremental hospitalization costs at different failure rates of the device versus assured prophylaxis administration with pegfilgrastim, reference filgrastim, or biosimilar filgrastim.
The researchers conducted a simulation analysis from a US payer perspective of the total incremental prophylaxis costs associated with OBI failure rates of 1% to 5% compared with assured prophylaxis administration in cycle 1 of chemotherapy for 10,000 enrolled patients with non-Hodgkin lymphoma (NHL). The failure rates were based on 2 prior publications: 2 Chrischilles, et al, and Osby, et al.
The authors estimated the associated incremental costs using the real-world daily injection regimens of filgrastim of 5 days, 6.5 days, and the standard 11 days. The costs were also based on first-quarter 2018 average selling price for drugs and the 2018 Current Procedural Terminology reimbursement levels.
Differential base rates of hospitalization in patients with NHL were computed for 2 chemotherapy regimens: cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) alone, or cyclophosphamide, mitoxantrone, vincristine, and prednisone (CNOP).
Except for 1 scenario in which a 0.1 failure rate of the pegfilgrastim OBI produced a $72,916 savings due to lower administration costs, every other scenario showed incremental costs associated with the pegfilgrastim OBI prophylaxis and failures of the OBI device.
The researchers determined that, per Chrischilles, et al, incremental hospitalization costs for FN ranged from $300,284 (at a .01 failure rate) to $1,501,422 (at .05 failure rate). The total incremental costs of OBI delivery over regular pegfilgrastim administration ranged from $227,369 to $1,128,222, and from $6,794,984 to $28,859,922 for OBI delivery versus reference filgrastim. The difference in cost was greatest for OBI delivery versus biosimilar filgrastim, at $19,00,984 to $34,409,922.
Per Osby, et al, the added cost of OBI delivery versus regular pegfilgrastim ranged from $135,757 to $2,171,584. Compared with reference filgrastim, OBI cost an added $7,003,657 to $29,903,284. Compared with biosimilar filgrastim, OBI cost an added $19,213,657 to $35,453,284.
Based on these results, the researchers concluded that the incremental costs of delivering pegfilgrastim via OBI for FN prophylaxis was lowest when compared with regular pegfilgrastim, and highest when compared with biosimilar filgrastim at a real-world duration of 5 days.
McBride A, Krendyukov A, Mathieson N, et al. Cost simulation for febrile neutropenia hospitalization in the US due to pegfilgrastim on-body injector failure compared to single-injection pegfilgrastim and daily injections with reference and biosimilar filgrastim in non-Hodgkin lymphoma. Presented at the 60th Annual Meeting and Exposition of the American Society of Hematology; December 1-4, 2018; San Diego, California. Abstract 2251. ash.confex.com/ash/2018/webprogram/Paper116315.html