Trilaciclib and the economic value of multilineage myeloprotection from chemotherapy-induced myelosuppression among patients with extensive-stage small cell lung cancer treated with first-line chemotherapy

Abstract

Aims

Proliferating hematopoietic stem and progenitor cells (HSPCs) are susceptible to chemotherapy-induced damage, resulting in myelosuppressive adverse events (AEs) such as neutropenia, anemia, and thrombocytopenia that are associated with high health care costs and decreased quality of life (QoL). In this study, a trial-based cost-effectiveness analysis was performed to help assess the economic impact of administering trilaciclib, a myeloprotective therapy that protects multilineage HSPCs from chemotherapy-induced damage, prior to standard first-line chemotherapy, using data from a pivotal Phase II study of trilaciclib in the setting of extensive-stage small cell lung cancer (ES-SCLC, NCT03041311).

Method

The aim of this study was to assess the cost-effectiveness of administering trilaciclib prior to chemotherapy versus chemotherapy alone among patients with ES-SCLC from a United States payer perspective. Data on the rate and frequency of myelosuppressive AEs and health utility were derived from the pivotal study of trilaciclib. Costs of managing myelosuppressive AEs and costs of chemotherapy treatment were sourced from published literature. Outcomes included the number of myelosuppressive AEs, costs (in 2021 US dollars), quality-adjusted life-years (QALYs), incremental cost, incremental QALY, and an incremental cost-effectiveness ratio.

Results

Administering trilaciclib prior to chemotherapy was associated with a reduction in neutropenia (82%), febrile neutropenia (75%), anemia (43%), and thrombocytopenia (96%) compared with chemotherapy alone. Additionally, trilaciclib prior to chemotherapy was cost-saving compared with chemotherapy alone ($99,919 vs $118,759, respectively) and associated with QALY improvement (0.150 vs 0.145, respectively). Probabilistic sensitivity analyses showed 58% of iterations projecting cost savings and QALY improvement with trilaciclib.

Conclusions

The findings suggest that the use of trilaciclib prior to first-line chemotherapy in patients with ES-SCLC can be cost-beneficial owing to fewer myelosuppressive AEs and lower costs, together with a favorable QoL profile.

Keywords:

• Anemia
• chemotherapy-induced myelosuppression
• economic evaluation
• neutropenia
• quality of life
• thrombocytopenia
• trilaciclib

JEL CLASSIFICATION CODES:

• I00
• I
• I10
• I1

Transparency

Declaration of funding

This work was supported by G1 Therapeutics, Inc.

Declaration of financial or other interests

IA and KM are equity shareholders in Matrix45, which is under contract with G1 Therapeutics, Inc. for services unrelated to this study and manuscript.

UO is an employee of ZS Associates.

BD was an employee of ZS Associates at the time of the study.

MC was an employee of G1 Therapeutics, Inc. at the time of the study and manuscript preparation. DM and HH are employees of G1 Therapeutics, Inc.

The peer reviewers on this manuscript have received an honorarium from JME for their review work and one of the reviewers was an author on one of the studies cited in this article. The other reviewers have no other relevant financial relationships to disclose.

Authors contributions

All authors were involved in the design of the study, the analysis of data, the interpretation of results, the drafting of the manuscript, and the final review.

Acknowledgements

The authors thank Avijeet Chopra (employee of ZS Associates at the time of manuscript preparation) for his editorial and programming assistance. The authors also thank Dinesh Mishra and Amit Goyal (employees of ZS Associates) for their assistance with model programming. Editorial assistance was provided by Alligent Europe (part of Envision Pharma Group), funded by G1 Therapeutics, Inc. The authors thank the anonymous reviewers for their valuable suggestions during the manuscript review process.

Data availability statement

The data that support the findings of this study are available from the co-author, H.H., upon reasonable request.

Previous presentations

Data included in this manuscript were presented, in part, at the International Society of Pharmacoeconomics and Outcomes Research 2021 Annual Meeting (PCN48): Deniz B, et al. Value in Health. 2021;24(Suppl_1):S27 (https://doi.org/10.1016/j.jval.2021.04.140)

Notes

i G1 Therapeutics, Inc., Research Triangle Park, NC, USA

ii NCCN. Clinical Practice Guidelines in Oncology. Small Cell Lung Cancer, version 3.2021. NCCN. Clinical Practice Guidelines in Oncology. Hematopoietic Growth Factors, version 4.2021.