Primary Prophylaxis With Biosimilar Filgrastim for Patients at Intermediate Risk for Febrile Neutropenia: A Cost-Effectiveness Analysis

Abstract

PURPOSE: Temporary COVID-19 guideline recommendations have recently been issued to expand the use of colony-stimulating factors in patients with cancer with intermediate to high risk for febrile neutropenia (FN). We evaluated the cost-effectiveness of primary prophylaxis (PP) with biosimilar filgrastim-sndz in patients with intermediate risk of FN compared with secondary prophylaxis (SP) over three different cancer types. METHODS: A Markov decision analytic model was constructed from the US payer perspective over a lifetime horizon to evaluate PP versus SP in patients with breast cancer, non–small-cell lung cancer (NSCLC), and non-Hodgkin lymphoma (NHL). Cost-effectiveness was evaluated over a range of willingness-to-pay thresholds for incremental cost per FN avoided, life year gained, and quality-adjusted life year (QALY) gained. Sensitivity analyses evaluated uncertainty. RESULTS: Compared with SP, PP provided an additional 0.102-0.144 LYs and 0.065-0.130 QALYs. The incremental cost-effectiveness ranged from $5,660 in US dollars (USD) to $20,806 USD per FN event avoided, $5,123 to $31,077 USD per life year gained, and $7,213 to $35,563 USD per QALY gained. Over 1,000 iterations, there were 73.6%, 99.4%, and 91.8% probabilities that PP was cost-effective at a willingness to pay of $50,000 USD per QALY gained for breast cancer, NSCLC, and NHL, respectively. CONCLUSION: PP with a biosimilar filgrastim (specifically filgrastim-sndz) is cost-effective in patients with intermediate risk for FN receiving curative chemotherapy regimens for breast cancer, NSCLC, and NHL. Expanding the use of colony-stimulating factors for patients may be valuable in reducing unnecessary health care visits for patients with cancer at risk of complications because of COVID-19 and should be considered for the indefinite future.

Trends in Use of Granulocyte Colony-Stimulating Factor Following Introduction of Biosimilars Among Adults With Cancer and Commercial or Medicare Insurance From 2014 to 2019

“…Evidence shows that using biosimilar G-CSFs for primary prophylaxis among patients with intermediate risk can be a cost-effective strategy even without risk factors. 31 , 32 , 33 Moreover, short-term guidance issued by NCCN also states that prophylactic G-CSF use among patients receiving intermediate-risk regimens may be considered in the context of the COVID-19 pandemic. 34 New evidence and guidelines highlight the need for future studies focusing on this patient subgroup to inform clinical and reimbursement decision-making.…”

Real-World Use of Granulocyte-Colony Stimulating Factor in Patients with Breast Cancer from Alberta, Canada

“…Prior to the availability of biosimilar G-CSF agents, primary prophylaxis with G-CSF may be less cost-effective for FN prevention in breast cancer, when compared to secondary prophylaxis [ 21 ]. However, a recent cost-effectiveness analysis of biosimilar filgrastim found primary prophylaxis to be cost-effective and supported expanding the use of G-CSF as an effective method of reducing unnecessary healthcare facility visits, especially in the context of the COVID-19 pandemic [ 22 ].…”

“…Moreover, numerous studies have suggested that the most cost-efficient approach to reducing the incidence of FN in chemotherapy-treated patients is through use of biosimilars and that savings could be used to expand access or reallocated to other anti-neoplastic therapy options on a budget-neutral basis [ 26 , 27 ]. Significant cost savings and increased access could potentially be realized for health systems that prioritize the use of biosimilars [ 22 ]. Nevertheless, the association between biosimilars and trends in G-CSF use in the Canadian context remains unclear and can be a compelling issue for additional investigation, including the extent to which FN-related hospitalizations have been impacted due to increased utilization of G-CSF prophylaxis.…”

The Impact of Baseline Risk Factors on the Incidence of Febrile Neutropenia in Breast Cancer Patients Receiving Chemotherapy with Pegfilgrastim Prophylaxis: A Real-World Data Analysis

“…33 An analysis of biosimilar filgrastim for primary prophylaxis in patients receiving intermediate-risk, curative chemotherapy regimens for BC, non-small cell lung cancer, and non-Hodgkin lymphoma found it was costeffective compared to secondary prophylaxis. 34 Biosimilar access will be important to the health-care system, as the full benefits and savings biosimilars may provide will only be realized with continued growth in uptake and utilization. The economic implications of pegfilgrastim and biosimilar administration should be investigated in future health economics and outcomes research evaluating biosimilar versus reference products and including a cost component.…”