Investigators: Biosimilar Pegfilgrastim Has Advantages Over Wearable Injector

December 1, 2020
Tony Hagen

Tony Hagen is senior managing editor for The Center for Biosimilars®.

The wearable injector has a failure rate that adds hospitalization costs; therefore, biosimilar pegfilgrastim may hold cost advantages, investigators conclude.

In a pair of simulation studies utilizing pegfilgrastim originator products and biosimilars, investigators set out to calculate the savings possible from switching to biosimilars and what could be achieved with those savings in terms of additional treatment. They found significant savings potential and concluded that hospitalization costs could be lowered by switching to biosimilar pegfilgrastim from the pegfilgrastim on-body injector (OBI).

The studies are due to be presented at the upcoming American Society of Hematology Annual Meeting and Exposition, December 5 to 8, 2020.

In one of the studies, investigators simulated the potential savings for a population of 20,000 patients with non-Hodgkin lymphoma.1 Based on average sales price (ASP) of the agents in question, they found that total savings of $371,444 were possible for the hypothetical patients if 10% were converted to pegfilgrastim biosimilar (Udenyca) from reference product or OBI and received 1 cycle of the prophylactic treatment (to prevent incidence of chemotherapy-induced febrile neutropenia). If 100% of patients were converted and received 6 cycles of treatment of the biosimilar, the potential savings climbed to $22.3 million.

Expanded Access

Using a blended ASP, wholesale acquisition cost (WAC) basis, investigators said the potential savings in a single cycle of chemotherapy meant it was possible to expand access to Udenyca by 524 cycles at a 10% conversion rate and 5243 cycles at 100% conversion. They said 4 patients would have to be converted to purchase 1 additional cycle of biosimilar pegfilgrastim.

To pay for an additional cycle of chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone plus rituximab (R-CHOP), 8 patients would need to be converted from 1 cycle of reference pegfilgrastim to Udenyca, they said. This calculation was also based on the ASP/WAC blended rate. Investigators said expanded access to R-CHOP ranged from 282 cycles at 10% conversion to 2817 cycles at 100% conversion for patients who received a single cycle of chemotherapy. Over multiple cycles, the savings were potentially much higher.

“These simulation models demonstrate that significant cost savings for supportive cancer care can be generated through conversion,” they wrote.

In the second study, investigators found that pegfilgrastim biosimilar (Fulphila) used as prophylaxis for chemotherapy-induced febrile neutropenia has savings and access advantages over pegfilgrastim originator product delivered via the OBI, which is available only for the reference product.2

The OBI has seen elevated usage during the coronavirus disease 2019 pandemic because it enables patients to receive doses outside the clinic, which is considered convenient and safe. However, investigators noted that the OBI has a failure rate of 1.7% to 6.9% that “predisposes patients to increased risk” of chemotherapy-related febrile neutropenia. These failures lead to hospitalizations. Cost savings generated from conversion to biosimilar pegfilgrastim (Fulphila) would create opportunities for expanded access, they wrote.

Investigators did a simulation analysis involving a cohort of 15,000 patients with diffuse large B-cell lymphoma at risk for febrile neutropenia. They said that after accounting for hospital costs related to OBI failure, the potential savings from the first cycle of prophylaxis at 10% conversion to the biosimilar were $406,118. This was based on an OBI failure rate of 1%. The savings climbed significantly based on additional cycles of treatment and higher assumed OBI failure rates.

Investigators said the savings translated into expanded access of 118 additional cycles of Fulphila or 62 cycles of R-CHOP, also at 10% conversion with a 1% OBI failure rate.

Prophylaxis with Fulphila generated substantial cost savings compared with OBI ($379,230; 1 cycle of prophylaxis at 10% conversion), the investigators wrote. They concluded that biosimilar savings further increased when the costs of febrile neutropenia–related hospitalization from pegfilgrastim OBI failure were factored in.


1. McBride A, MacDonald K, Abraham I. Simulation modeling of cost-savings from conversion to biosimilar pegfilgrastim-cbqv for the prophylaxis of chemotherapy-induced neutropenia, and budget-neutral expanded access to prophylaxis and anti-neoplastic therapy from derived cost-savings in non-Hodgkin lymphoma. Presented at: 62nd ASH Annual Meeting and Exposition; December 5-8, 2020. Abstract 3425.

2. McBride A, MacDonald K, Abraham I. Conversion to biosimilar pegfilgrastim-jmdb from pegfilgrastim with on-body injector device in diffuse large B-cell lymphoma: simulation modeling of cost-savings and budget-neutral expanded access to prophylaxis and anti-neoplastic therapy considering device failure rate. Presented at: 62nd ASH Annual Meeting and Exposition; December 5-8, 2020. Abstract 3422.