Cost-efficiency and expanded access of prophylaxis for chemotherapy-induced (febrile) neutropenia: economic simulation analysis for the US of conversion from reference pegfilgrastim to biosimilar pegfilgrastim-cbqv

Figures & data

Table 1. Costs of medications and administration.

	Administration^a	ASP^b	ASP + Administration	WAC^c	WAC + Administration	Blended^d	Blended + Administration
Pegfilgrastim-cbqv	$60.46	$3,464.61	$3,525.07	$4,175.00	$4,235.46	$3,788.19	$3,848.65
Pegfilgrastim PFS	$60.46	$3,650.33	$3,710.79	$6,231.06	$6,291.52	$4,825.86	$4,886.32
Pegfilgrastim OBI	$38.11	$3,650.33	$3,688.44	$6,231.06	$6,269.17	$4,825.86	$4,863.97

Abbreviations. OBI, on-body injector; PFS, pre-filled syringe.

^aCMS 2020 Hospital Outpatient Prospective Payment System payment per Healthcare Common Procedure Coding System (HCPCS) code. For pegfilgrastim-cbqv and pegfilgrastim PFS: HCPCS 96372; for pegfilgrastim OBI: HCPCS 96377.

Source: CMS-1717-FC Medicare Program: Changes to Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs, Addendum B.-Final OPPS Payment by HCPCS Code for CY 2020. (https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS-1717-FC).

^bAverage Sales Price. For pegfilgrastim-cbqv: 1Q2020 biosimilar ASP (reimbursement limit minus 4.3 add-on of reference). For pegfilgrastim and pegfilgrastim OBI: 1Q2020 reference ASP (payment limit minus 4.3% add-on).

Source: CMS-1717-FC Medicare Program: Changes to Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs, Addendum B. Final OPPS Payment by HCPCS Code for CY 2020. (https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS-1717-FC).

^cWholesale Acquisition Cost: 2020 IBM Micromedex RED BOOK.

^dAge-proportional blended ASP and WAC rate, assuming that cancer patients <65 years old (45.55%) have commercial insurance (represented by WAC) and those age 65 and older (54.45%) will have Medicare (represented by ASP). Age proportions are per the most recently reported Surveillance, Epidemiology, and End Results (SEER) Program (2013–2017, all races, both sexes) (https://seer.cancer.gov/statfacts/html/all.html).

Table 2. Per-patient savings from biosimilar conversion to pegfilgrastim-cbqv by number of cycles of GCSF support.

Cycles of GCSF support	1	2	3	4	5	6
Average sales price (ASP) + administration
Cumulative cost of GCSF support across cycles
Pegfilgrastim-cbqv	$3,525	$7,050	$10,575	$14,100	$17,625	$21,150
Pegfilgrastim PFS	$3,711	$7,422	$11,132	$14,843	$18,554	$22,265
Pegfilgrastim OBI	$3,688	$7,377	$11,065	$14,754	$18,442	$22,131
Savings from conversion to pegfilgrastim-cbqv
From Pegfilgrastim PFS	$186	$371	$557	$743	$929	$1,114
From Pegfilgrastim OBI	$163	$327	$490	$653	$817	$980
Wholesale acquisition cost (WAC) + administration
Cumulative cost of GCSF support across cycles
Pegfilgrastim-cbqv	$4,235	$8,471	$12,706	$16,942	$21,177	$25,413
Pegfilgrastim PFS	$6,292	$12,583	$18,875	$25,166	$31,458	$37,749
Pegfilgrastim OBI	$6,269	$12,538	$18,808	$25,077	$31,346	$37,615
Savings from conversion to pegfilgrastim-cbqv
From Pegfilgrastim PFS	$2,056	$4,112	$6,168	$8,224	$10,280	$12,336
From Pegfilgrastim OBI	$2,034	$4,067	$6,101	$8,135	$10,169	$12,202
Age-proportional blended ASP and WAC + administration
Cumulative cost of GCSF support across cycles
Pegfilgrastim-cbqv	$3,849	$7,697	$11,546	$15,395	$19,243	$23,092
Pegfilgrastim PFS	$4,886	$9,773	$14,659	$19,545	$24,432	$29,318
Pegfilgrastim OBI	$4,864	$9,728	$14,592	$19,456	$24,320	$29,184
Savings from conversion to pegfilgrastim-cbqv
From Pegfilgrastim PFS	$1,038	$2,075	$3,113	$4,151	$5,188	$6,226
From Pegfilgrastim OBI	$1,015	$2,031	$3,046	$4,061	$5,077	$6,092

Abbreviations. PFS, pre-filled syringe; OBI, on-body injector.

All estimates are rounded to the nearest dollar.

Table 3. Total savings from biosimilar conversion to pegfilgrastim-cbqv stratified by costing base, conversion rates, and number of cycles of GCSF support in a panel of 20,000 patients.

Cycles of GCSF support		1	2	3	4	5	6
Conversion rate (%)	Patients	Average sales price (ASP) + administration
		Savings from conversion from pegfilgrastim PFS to pegfilgrastim-cbqv
100	20,000	$3,714,440	$7,428,880	$11,143,320	$14,857,760	$18,572,200	$22,286,640
90	18,000	$3,342,996	$6,685,992	$10,028,988	$13,371,984	$16,714,980	$20,057,976
80	16,000	$2,971,552	$5,943,104	$8,914,656	$11,886,208	$14,857,760	$17,829,312
70	14,000	$2,600,108	$5,200,216	$7,800,324	$10,400,432	$13,000,540	$15,600,648
60	12,000	$2,228,664	$4,457,328	$6,685,992	$8,914,656	$11,143,320	$13,371,984
50	10,000	$1,857,220	$3,714,440	$5,571,660	$7,428,880	$9,286,100	$11,143,320
40	8,000	$1,485,776	$2,971,552	$4,457,328	$5,943,104	$7,428,880	$8,914,656
30	6,000	$1,114,332	$2,228,664	$3,342,996	$4,457,328	$5,571,660	$6,685,992
20	4,000	$742,888	$1,485,776	$2,228,664	$2,971,552	$3,714,440	$4,457,328
10	2,000	$371,444	$742,888	$1,114,332	$1,485,776	$1,857,220	$2,228,664
		Savings from conversion from pegfilgrastim OBI to pegfilgrastim-cbqv
100	20,000	$3,267,440	$6,534,880	$9,802,320	$13,069,760	$16,337,200	$19,604,640
90	18,000	$2,940,696	$5,881,392	$8,822,088	$11,762,784	$14,703,480	$17,644,176
80	16,000	$2,613,952	$5,227,904	$7,841,856	$10,455,808	$13,069,760	$15,683,712
70	14,000	$2,287,208	$4,574,416	$6,861,624	$9,148,832	$11,436,040	$13,723,248
60	12,000	$1,960,464	$3,920,928	$5,881,392	$7,841,856	$9,802,320	$11,762,784
50	10,000	$1,633,720	$3,267,440	$4,901,160	$6,534,880	$8,168,600	$9,802,320
40	8,000	$1,306,976	$2,613,952	$3,920,928	$5,227,904	$6,534,880	$7,841,856
30	6,000	$980,232	$1,960,464	$2,940,696	$3,920,928	$4,901,160	$5,881,392
20	4,000	$653,488	$1,306,976	$1,960,464	$2,613,952	$3,267,440	$3,920,928
10	2,000	$326,744	$653,488	$980,232	$1,306,976	$1,633,720	$1,960,464
		Wholesale Acquisition Cost (WAC) + Administration
		Savings from conversion from pegfilgrastim PFS to pegfilgrastim-cbqv
100	20,000	$41,121,200	$82,242,400	$123,363,600	$164,484,800	$205,606,000	$246,727,200
90	18,000	$37,009,080	$74,018,160	$111,027,240	$148,036,320	$185,045,400	$222,054,480
80	16,000	$32,896,960	$65,793,920	$98,690,880	$131,587,840	$164,484,800	$197,381,760
70	14,000	$28,784,840	$57,569,680	$86,354,520	$115,139,360	$143,924,200	$172,709,040
60	12,000	$24,672,720	$49,345,440	$74,018,160	$98,690,880	$123,363,600	$148,036,320
50	10,000	$20,560,600	$41,121,200	$61,681,800	$82,242,400	$102,803,000	$123,363,600
40	8,000	$16,448,480	$32,896,960	$49,345,440	$65,793,920	$82,242,400	$98,690,880
30	6,000	$12,336,360	$24,672,720	$37,009,080	$49,345,440	$61,681,800	$74,018,160
20	4,000	$8,224,240	$16,448,480	$24,672,720	$32,896,960	$41,121,200	$49,345,440
10	2,000	$4,112,120	$8,224,240	$12,336,360	$16,448,480	$20,560,600	$24,672,720
		Savings from conversion from pegfilgrastim OBI to pegfilgrastim-cbqv
100	20,000	$40,674,200	$81,348,400	$122,022,600	$162,696,800	$203,371,000	$244,045,200
90	18,000	$36,606,780	$73,213,560	$109,820,340	$146,427,120	$183,033,900	$219,640,680
80	16,000	$32,539,360	$65,078,720	$97,618,080	$130,157,440	$162,696,800	$195,236,160
70	14,000	$28,471,940	$56,943,880	$85,415,820	$113,887,760	$142,359,700	$170,831,640
60	12,000	$24,404,520	$48,809,040	$73,213,560	$97,618,080	$122,022,600	$146,427,120
50	10,000	$20,337,100	$40,674,200	$61,011,300	$81,348,400	$101,685,500	$122,022,600
40	8,000	$16,269,680	$32,539,360	$48,809,040	$65,078,720	$81,348,400	$97,618,080
30	6,000	$12,202,260	$24,404,520	$36,606,780	$48,809,040	$61,011,300	$73,213,560
20	4,000	$8,134,840	$16,269,680	$24,404,520	$32,539,360	$40,674,200	$48,809,040
10	2,000	$4,067,420	$8,134,840	$12,202,260	$16,269,680	$20,337,100	$24,404,520
		Age-proportional blended ASP and WAC + administration
		Savings from conversion from pegfilgrastim PFS to pegfilgrastim-cbqv
100	20,000	$20,753,219	$41,506,438	$62,259,658	$83,012,877	$103,766,096	$124,519,315
90	18,000	$18,677,897	$37,355,795	$56,033,692	$74,711,589	$93,389,486	$112,067,384
80	16,000	$16,602,575	$33,205,151	$49,807,726	$66,410,301	$83,012,877	$99,615,452
70	14,000	$14,527,253	$29,054,507	$43,581,760	$58,109,014	$72,636,267	$87,163,521
60	12,000	$12,451,932	$24,903,863	$37,355,795	$49,807,726	$62,259,658	$74,711,589
50	10,000	$10,376,610	$20,753,219	$31,129,829	$41,506,438	$51,883,048	$62,259,658
40	8,000	$8,301,288	$16,602,575	$24,903,863	$33,205,151	$41,506,438	$49,807,726
30	6,000	$6,225,966	$12,451,932	$18,677,897	$24,903,863	$31,129,829	$37,355,795
20	4,000	$4,150,644	$8,301,288	$12,451,932	$16,602,575	$20,753,219	$24,903,863
10	2,000	$2,075,322	$4,150,644	$6,225,966	$8,301,288	$10,376,610	$12,451,932
		Savings from conversion from pegfilgrastim OBI to pegfilgrastim-cbqv
100	20,000	$20,306,219	$40,612,438	$60,918,658	$81,224,877	$101,531,096	$121,837,315
90	18,000	$18,275,597	$36,551,195	$54,826,792	$73,102,389	$91,377,986	$109,653,584
80	16,000	$16,244,975	$32,489,951	$48,734,926	$64,979,901	$81,224,877	$97,469,852
70	14,000	$14,214,353	$28,428,707	$42,643,060	$56,857,414	$71,071,767	$85,286,121
60	12,000	$12,183,732	$24,367,463	$36,551,195	$48,734,926	$60,918,658	$73,102,389
50	10,000	$10,153,110	$20,306,219	$30,459,329	$40,612,438	$50,765,548	$60,918,658
40	8,000	$8,122,488	$16,244,975	$24,367,463	$32,489,951	$40,612,438	$48,734,926
30	6,000	$6,091,866	$12,183,732	$18,275,597	$24,367,463	$30,459,329	$36,551,195
20	4,000	$4,061,244	$8,122,488	$12,183,732	$16,244,975	$20,306,219	$24,367,463
10	2,000	$2,030,622	$4,061,244	$6,091,866	$8,122,488	$10,153,110	$12,183,732

Abbreviations. PFS, pre-filled syringe; OBI, on-body injector.

All estimates are rounded to the nearest dollar.

Table 4. Expanded access to additional pegfilgrastim-cbqv doses that be purchased on a budget neutral basis from conversion to pegfilgrastim-cbqv in a panel of 20,000 patients.

Cycles of GCSF support	Patients	1	2	3	4	5	6
Conversion rate (%)		Average sales price (ASP) + administration
		Additional pegfilgrastim-cbqv doses that can be purchased from conversion from pegfilgrastim PFS
100	20,000	1,054	2,107	3,161	4,215	5,269	6,322
90	18,000	948	1,897	2,845	3,793	4,742	5,690
80	16,000	843	1,686	2,529	3,372	4,215	5,058
70	14,000	738	1,475	2,213	2,950	3,688	4,426
60	12,000	632	1,264	1,897	2,529	3,161	3,793
50	10,000	527	1,054	1,581	2,107	2,634	3,161
40	8,000	421	843	1,264	1,686	2,107	2,529
30	6,000	316	632	948	1,264	1,581	1,897
20	4,000	211	421	632	843	1,054	1,264
10	2,000	105	211	316	421	527	632
		Additional pegfilgrastim-cbqv doses that can be purchased from conversion from pegfilgrastim OBI
100	20,000	927	1,854	2,781	3,708	4,635	5,561
90	18,000	834	1,668	2,503	3,337	4,171	5,005
80	16,000	742	1,483	2,225	2,966	3,708	4,449
70	14,000	649	1,298	1,947	2,595	3,244	3,893
60	12,000	556	1,112	1,668	2,225	2,781	3,337
50	10,000	463	927	1,390	1,854	2,317	2,781
40	8,000	371	742	1,112	1,483	1,854	2,225
30	6,000	278	556	834	1,112	1,390	1,668
20	4,000	185	371	556	742	927	1,112
10	2,000	93	185	278	371	463	556
		Wholesale acquisition cost (WAC) + administration
		Additional pegfilgrastim-cbqv doses that can be purchased from conversion from pegfilgrastim PFS
100	20,000	9,709	19,418	29,126	38,835	48,544	58,253
90	18,000	8,738	17,476	26,214	34,952	43,690	52,427
80	16,000	7,767	15,534	23,301	31,068	38,835	46,602
70	14,000	6,796	13,592	20,388	27,185	33,981	40,777
60	12,000	5,825	11,651	17,476	23,301	29,126	34,952
50	10,000	4,854	9,709	14,563	19,418	24,272	29,126
40	8,000	3,884	7,767	11,651	15,534	19,418	23,301
30	6,000	2,913	5,825	8,738	11,651	14,563	17,476
20	4,000	1,942	3,884	5,825	7,767	9,709	11,651
10	2,000	971	1,942	2,913	3,884	4,854	5,825
		Additional pegfilgrastim-cbqv doses that can be purchased from conversion from pegfilgrastim OBI
100	20,000	9,603	19,207	28,810	38,413	48,016	57,620
90	18,000	8,643	17,286	25,929	34,572	43,215	51,858
80	16,000	7,683	15,365	23,048	30,730	38,413	46,096
70	14,000	6,722	13,445	20,167	26,889	33,611	40,334
60	12,000	5,762	11,524	17,286	23,048	28,810	34,572
50	10,000	4,802	9,603	14,405	19,207	24,008	28,810
40	8,000	3,841	7,683	11,524	15,365	19,207	23,048
30	6,000	2,881	5,762	8,643	11,524	14,405	17,286
20	4,000	1,921	3,841	5,762	7,683	9,603	11,524
10	2,000	960	1,921	2,881	3,841	4,802	5,762
		Age-proportional Blended ASP and WAC + Administration
		Additional pegfilgrastim-cbqv doses that can be purchased from conversion from pegfilgrastim PFS
100	20,000	5,392	10,785	16,177	21,569	26,962	32,354
90	18,000	4,853	9,706	14,559	19,412	24,265	29,119
80	16,000	4,314	8,628	12,942	17,255	21,569	25,883
70	14,000	3,775	7,549	11,324	15,099	18,873	22,648
60	12,000	3,235	6,471	9,706	12,942	16,177	19,412
50	10,000	2,696	5,392	8,088	10,785	13,481	16,177
40	8,000	2,157	4,314	6,471	8,628	10,785	12,942
30	6,000	1,618	3,235	4,853	6,471	8,088	9,706
20	4,000	1,078	2,157	3,235	4,314	5,392	6,471
10	2,000	539	1,078	1,618	2,157	2,696	3,235
		Additional pegfilgrastim-cbqv doses that can be purchased from conversion from pegfilgrastim OBI
100	20,000	5,276	10,552	15,829	21,105	26,381	31,657
90	18,000	4,749	9,497	14,246	18,994	23,743	28,491
80	16,000	4,221	8,442	12,663	16,884	21,105	25,326
70	14,000	3,693	7,387	11,080	14,773	18,467	22,160
60	12,000	3,166	6,331	9,497	12,663	15,829	18,994
50	10,000	2,638	5,276	7,914	10,552	13,190	15,829
40	8,000	2,110	4,221	6,331	8,442	10,552	12,663
30	6,000	1,583	3,166	4,749	6,331	7,914	9,497
20	4,000	1,055	2,110	3,166	4,221	5,276	6,331
10	2,000	528	1,055	1,583	2,110	2,638	3,166

Abbreviations. PFS, pre-filled syringe; OBI, on-body injector.

All estimates are rounded to the nearest integer.

Table 5. Number of patients needed to convert (NNC) to purchase 1 additional dose of pegfilgrastim-cbqv on a budget-neutral basis.

	Number of cycles of GCSF support for a given patient
	1	2	3	4	5	6
	NNC to purchase 1 additional dose of pegfilgrastim-cbqv
Average sales price (ASP) + administration
From pegfilgrastim PFS to pegfilgrastim-cbqv	18.98	9.49	6.33	4.75	3.80	3.16
From pegfilgrastim OBI to pegfilgrastim-cbqv	21.58	10.79	7.19	5.39	4.32	3.60
Wholesale acquisition cost (WAC) + administration
From pegfilgrastim PFS to pegfilgrastim-cbqv	2.06	1.03	0.69	0.51	0.41	0.34
From pegfilgrastim OBI to pegfilgrastim-cbqv	2.08	1.04	0.69	0.52	0.42	0.35
Age-proportional blended ASP and WAC + administration
From pegfilgrastim PFS to pegfilgrastim-cbqv	3.71	1.85	1.24	0.93	0.74	0.62
From pegfilgrastim OBI to pegfilgrastim-cbqv	3.79	1.90	1.26	0.95	0.76	0.63

Abbreviations. PFS, pre-filled syringe; OBI, on-body injector.