Given On-Body Injector Failure With Pegfilgrastim, Biosimilar Filgrastim Offers Greatest Cost Efficiency

Using granulocyte colony-stimulating factor (G-CSF) therapies is a guideline-recommended way to decrease the incidence of febrile neutropenia (FN), a serious adverse event related to myelosuppressive chemotherapy that can result in dose delays, dose reductions, or cycle cancellations—all of which are linked with increased morbidity and mortality for patients with cancer—as well as substantially increased costs related to hospitalization.

Long-acting G-CSF options (such as pegfilgrastim) and short-acting options (such as filgrastim) are indicated to reduce the incidence of FN, and data have shown that there is little difference in efficacy among these therapies when they are dosed according to recommended guidelines.¹

However, administering the brand-name pegfilgrastim (Neulasta) via an on-body injection device (sold as Onpro), does carry some risk of device failure, resulting in a missed or partial dose of pegfilgrastim. A recent cost simulation found that, when taking into account on-body device failure for the brand-name pegfilgrastim, assured prophylaxis with biosimilar filgrastim offers the greatest cost efficiency.²

The study used a general simulation model for 2018 that considered on-body device failure rates of 1% to 10% in the first cycle of chemotherapy (versus assured prophylaxis with pegfilgrastim, reference filgrastim, or the biosimilar filgrastim Zarxio) for patients with non-Hodgkin lymphoma (NHL) and lung cancer, 2 highly incident, highly prevalent cancers.

Cost inputs were derived from average selling prices for the drugs from the first quarter of 2018 from the Medicare Part B drug payment limits. Administration costs derived from the 2018 physician fee schedule, and FN-related hospitalization costs were derived from 2012 costs that were adjusted to 2018 pricing.

For a panel of 10,000 patients with lung cancer, the total incremental cost of on-body administered prophylaxis at varying failure rates and durations ranged from $6,691,969 to $31,765,299 more than prophylaxis with brand-name filgrastim, and from $18,901,969 to $36,538,299 more than prophylaxis with the biosimilar.

Among a panel of the same size comprising patients with NHL, using an incremental hospitalization-risk derived from a 2002 study on the length of hospital stays related to FN, the total incremental costs of on-body administered pegfilgrastim ranged from $6,794,984 to $30,361,345 more than brand-name filgrastim and from $19,004,984 to $35,911,345 more than biosimilar filgrastim.

Using an incremental hospitalization-risk derived from a 2003 randomized trial, incremental costs ranged from $7,003,657 to $32,448,067 more than brand-name filgrastim and $19,213,657 to $37,998,067 more than biosimilar filgrastim.

The authors write that “the economic dynamics of the known problem of failure of the [Onpro] device, the loss of prophylaxis, and the increase in FN risk versus prophylaxis with injected pegylated or standard filgrastim result in a triple benefit: with injection, prophylaxis is assured, FN outcomes are better, and costs are lower.”

While the study was limited by the use of publicly available cost inputs, and while and simulations are also needed to assess device failure on the frequency of chemotherapy-induced neutropenia in addition to FN, this simulation demonstrates that using biosimilar filgrastim offers the greatest cost efficiency in the prophylaxis of FN.

References

1. Cornes P, Gascon P, Chan S, et al. Systematic review and meta-analysis of short- versus long-acting granulocyte colony-stimulating factors for reduction of chemotherapy-induced febrile neutropenia. Adv Ther. 2018;35(11): 1816-1829. doi: 10.1007/s12325-018-0798-6.

2. McBride A, Krendyukov A, Mathieson N, et al. Febrile neutropenia hospitalization due to pegfilgrastim on-body injector failure compared to single-injection pegfilgrastim and daily injections with reference and biosimilar filgrastim: US cost simulation for lung cancer and non-Hodgkin lymphoma [published online August 21, 2019]. J Med Econ. doi: 10.1080/13696998.2019.1658591.