Real-world cost-effectiveness of primary prophylaxis with G-CSF biosimilars in patients at intermediate/high risk of febrile neutropenia.

ABSTRACT

Background: Real-world data suggests superiority of pegfilgrastim (PEG) over filgrastim (FIL) in reducing the incidence of chemotherapy-induced febrile neutropenia (FN), probably attributable to underdosed FIL in practice. We used real-world data to assess the cost-effectiveness of primary prophylaxis with PEG versus FIL in cancer patients at intermediate-to-high risk of FN from a US payer perspective. Methods: A Markov model with lifetime horizon. Results: For the high-risk group, PEG (vs FIL) biosimilars resulted in 0.43 FN events prevented (FNp), 0.27 quality-adjusted life-years gained (QALYg) and a cost saving of USD$5703. For the intermediate-risk group, PEG biosimilar led to 0.18 FNp and 0.12 QALYg, at USD$9674/FNp and USD$14,502/QALYg. Conclusion: PEG biosimilars may provide opportunities to optimize FN management in patients with intermediate-to-high FN risk.

Our results have demonstrated that, by taking the real-world dosing and effectiveness of pegfilgrastim versus filgrastim into account, pegfilgrastim biosimilars have the potential to financially optimize neutropenia management in cancer patients by reducing febrile neutropenia (FN) incidence and FN-related healthcare resource utilization, and to potentially improve health outcomes. Extending primary prophylaxis with pegfilgrastim biosimilars from cancer patients with high-to-intermediate risk of FN resulted in clinical benefits, at acceptable incremental costs. Given the accelerated availability of pegfilgrastim biosimilars, it is important to instigate a rethink of FN management in cancer patients and implement guidelines that maximize the benefits of pegfilgrastim both clinically and economically.