Conversion from pegfilgrastim with on-body injector to pegfilgrastim-jmdb: cost-efficiency analysis and budget-neutral expanded access to prophylaxis and treatment

Abstract

Aims

Therapeutic guidelines recommend prophylaxis against chemotherapy-induced (febrile) neutropenia (CIN/FN). Pegfilgrastim (Neulasta), biosimilar pegfilgrastim-jmdb (Fulphila), and pegfilgrastim with on-body injector (OBI; Neulasta Onpro) are options for CIN/FN prophylaxis. We aimed to simulate the cost-savings and budget-neutral expanded access to CIN/FN prophylaxis or anticancer treatment achieved through conversion from pegfilgrastim-OBI to pegfilgrastim-jmdb and to evaluate the economic impact of FN-related hospitalization costs due to pegfilgrastim-OBI failure.

Methods

Cost-savings from conversion from pegfilgrastim-OBI to biosimilar pegfilgrastim-jmdb were simulated in a panel of 15,000 patients with cancer from the US payer perspective. The primary analyses included conversion rates of 10% to 100%. Adjusted analyses also considered OBI device failure rates of 1% to 7% and associated costs of FN-related hospitalization. Simulations of budget-neutral expanded access to prophylaxis with pegfilgrastim-jmdb or to rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) for diffuse large B-cell lymphoma (DLBCL) were also performed.

Results

In a 15,000-patient panel, conversion from pegfilgrastim-OBI to pegfilgrastim-jmdb resulted in cost-savings ranging from $481,259 (10% conversion) to $4,812,585 (100% conversion) in a single cycle. Over 6 cycles at 100% conversion, savings were $28,857,510 and could provide 9,191 additional doses of pegfilgrastim-jmdb or 4,463 cycles of R-CHOP to patients with DLBCL. Adjusted for OBI failure, cost-savings over 6 cycles ranged from $2,935,565 (10% conversion; pegfilgrastim-OBI failure rate of 1%) to $32,236,499 (100% conversion; 7% failure). These cost-savings could provide 943 doses of pegfilgrastim-jmdb or 454 doses of R-CHOP (10% conversion; 1% pegfilgrastim-OBI failure) or provide 10,261 doses of pegfilgrastim-jmdb or 4,982 cycles of R-CHOP (100% conversion; 7% failure).

Conclusion

Conversion from pegfilgrastim to pegfilgrastim-jmdb is associated with significant cost-savings which increase markedly when also accounting for pegfilgrastim-OBI failure and associated FN-related hospitalizations. These general and failure-related cost-savings could be allocated on a budget-neutral basis to provide more patients with additional CIN/FN prophylaxis or antineoplastic treatment.

Keywords:

• Biosimilars
• cost-efficiency
• expanded access
• febrile neutropenia
• G-CSF
• neutropenia
• pegfilgrastim

JEL classification codes:

• A10
• C19

Transparency

Declaration of funding

This study was funded by Viatris, Inc.

Declaration of financial/other interests

Ali McBride has been a speaker and consultant for Pfizer, Coherus, and Mylan.

Karen MacDonald and Ivo Abraham are equity shareholders of Matrix45, LLC, and, by company policy, are prohibited from owning equity in client organizations (except through mutual funds or other independently administered collective investment instruments) or contracting independently with client organizations. Matrix45 provides similar services to those described in this article to other biopharmaceutical companies on a non-exclusive basis.

Adolfo Fuentes-Alburo is an employee of Viatris.

Ivo Abraham is the Deputy Editor-in-Chief of the Journal of Medical Economics and was not involved in the editorial processing or decisions related to this manuscript.

JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

The authors involved in the conception and design or analysis/interpretation and review of the manuscript are Ali McBride, Karen MacDonald, Adolfo Fuentes-Alburo, and Ivo Abraham.

Acknowledgements

Technical, editorial, and medical writing assistance were provided under the direction of the authors by Yasser Heakal, PhD, and Strategix, an affiliate of The Lynx Group LLC under funding by Viatris, Inc.

Previous presentations

The study was presented at the 2020 American Society of Hematology Annual Meeting: 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. Blood. 2020;136(Suppl 1):22.