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Pegfilgrastim Biosimilars Provide Clinical, Economic Benefits to Prevent Febrile Neutropenia


An analysis of real-world dosing and effectiveness of pegfilgrastim biosimilars found the clinical benefits of preventing febrile neutropenia in patients with intermediate to high risk come at acceptable financial costs compared with filgrastim biosimilars.

Febrile neutropenia (FN) hospitalizes approximately 60,000 US patients every year and costs $28,000 per admission. A new study has shown that biosimilar pegfilgrastim (PEG) as primary prophylaxis in patients with cancer and an intermediate to high risk of chemotherapy-induced neutropenia can save on spending.

The findings were published in Future Oncology.

FN also causes delays, dose reductions, and discontinuation of chemotherapy schedules, all of which reduce survival rates for patients with cancer. The biologics filgrastim (FIL) and PEG reduce FN incidence and are recommended to prevent neutropenia. PEG is a long-acting formulation that has advanced management of neutropenia in patients with cancer, but has higher costs compared with FIL.

“The benefits of PEG biosimilars will be multiple,” the authors explained. “The first impact will be in welcome savings for hard-pressed hospital drug budgets. The second benefit will be in changing the balance of real-world value between the long-acting PEG and its short-acting alternative, FIL, which is one of the objectives of the present study.”

They used real-world data to assess the cost-effectiveness of PEG vs FIL in patients at high-risk of FN (> 20% risk) and at intermediate-risk of FN (10%-20% risk). They looked at PEG biosimilars, PEG reference in a prefilled syringe, PEG reference in an on-body injector, FIL biosimilars, and FIL reference; however, since the biosimilars always outperformed the reference products, the researchers focused their findings in the study on the biosimilars.

In the high-risk group:

  • PEG led to 0.28 quality-adjusted life-years (QALYs) gained, 0.32 life-years (LYs) gained, and 0.43 FN events prevented per patient compared with FIL
  • The total estimated costs for PEG biosimilar were $102,576 vs $108,279 for FIL biosimilar
  • The PEG biosimilar savings were driven by reduced FN incidence resulting in lower costs for inpatient FN management
  • Similarly, the PEG reference products were superior to the FIL reference product

In the intermediate-risk group:

  1. PEG led to 0.12 quality-adjusted life-years (QALYs) gained, 0.14 life-years (LYs) gained, and 0.18 FN events prevented per patient compared with FIL
  2. The total estimated costs for PEG biosimilar were $106,811 vs $105,059 for FIL biosimilar
  3. The higher cost of PEG biosimilar was driven by the higher cost of PEG biosimilar; however, this higher cost was partially offset by lower costs for FN management
  4. As with the high-risk group, the PEG reference products were also superior to the FIL reference product

Probabilistic sensitivity analyses determined the probability of PEG biosimilar being cost-effective compared with FIL biosimilar at a willingness-to-pay threshold of $100,000 per QALY gained, per LY gained, and per FN event avoided to be 100%, 100%, and 100%.

In addition to primary prophylactic use of biosimilar PEG being cost-saving in patients with a high-risk of FN, extending PEG prophylaxis in patients with intermediate-risk of FN is cost-effective, assuming a threshold for the WTP per QALY gained of $50,000 to $200,000, the authors determined.

“The introduction of PEG biosimilar urges a re-evaluation of current treatment guidelines for G-CSF [granulocyte colony-stimulating factors] use in neutropenia management,” the authors concluded. “A multidisciplinary effort that involves treating oncologists, nurses, pharmacists and patients is needed to fully release the value of G-CSF biosimilars.”


Cornes P, Kelton J, Liu R, Zaidi O, Stephens J, Yang J. Real-world cost-effectiveness of primary prophylaxis with G-CSF biosimilars in patients at intermediate/high risk of febrile neutropenia. Future Oncol. Published online March 31, 2022. doi:10.2217/fon-2022-0095

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