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

Abstract

Aims: In this pharmacoeconomic simulation, we: (1) modeled the cost-efficiency of converting patients from reference pegfilgrastim to biosimilar pegfilgrastim-cbqv for prophylaxis of chemotherapy-induced (febrile) neutropenia (CIN/FN) from the US payer perspective, (2) simulated how savings enable, on a budget-neutral basis, expanded access to pegfilgrastim-cbqv, and (3) estimated the number-neededto-convert (NNC) to purchase one additional dose of pegfilgrastim-cbqv. Methods: In a hypothetical panel of 20,000 patients, we modeled cost-savings utilizing: two reference formulations (pre-filled syringe [PFS] and on-body injector [OBI]), three medication cost inputs (average sales price [ASP], wholesale acquisition cost [WAC], and an age-proportionate blended ASP/WAC rate), administration cost for injection (PFS) and device application (OBI), conversion rates of 10-100%, and 1-6 cycles of prophylaxis. Cost-savings were used to estimate additional doses of pegfilgrastim-cbqv that could be purchased and the NNC to purchase one additional dose. Results: Using ASP and 10% conversion from reference OBI to pegfilgrastim-cbqv, savings range from $326,744 (1 cycle) to $2.0M (6 cycles) which could provide 93-556 additional doses of pegfilgrastimcbqv, respectively; the NNC to purchase one additional dose of pegfilgrastim-cbqv ranges from 21.6 (1 cycle) down to 3.6 patients (6 cycles). The WAC model saves $41.1M per cycle and $246.7M over 6 cycles at 100% conversion from reference PFS which could provide 9,709-58,253 additional pegfilgrastim-cbqv doses; the NNC ranges from 2.1 (1 cycle) to 0.3 (6 cycles). Using the blended ASP/WAC rate, converting 50% from reference OBI to pegfilgrastim-cbqv would save $10.2M per cycle and $60.9M over 6 cycles providing 2,638-15,829 additional doses of pegfilgrastim-cbqv; NNCs are 3.8 (1 cycle) and 0.6 patients (6 cycles). Conclusions: Converting 20,000 patients from reference to pegfilgrastim-cbqv over 6 cycles can generate savings up to $246.7M, enough to purchase up to 58,253 additional doses of pegfilgrastim-cbqv. This simulation provides economic justification for prophylaxis with biosimilar pegfilgrastim-cbqv.

Cost-efficiency and expanded access modeling of conversion to biosimilar trastuzumab-dkst with or without pertuzumab in metastatic breast cancer

“…This first cost-efficiency and expanded access analysis on conversion to therapeutic biosimilars is consistent with prior investigations in the supportive cancer care settings [2][3][4][5][6][7][8][9][10].…”

“…There is a concomitant need to investigate the potential cost-efficiency offered by therapeutic biosimilars and to assess their potential impact on healthcare and market dynamics. Our previous pharmacoeconomic studies have demonstrated the potential cost-efficiency, the opportunities for budget-neutral (that is, from the accrued savings, without further impact on, and within the constraints of, budget) expanded patient access to cancer care, and, more generally, the economic value of biosimilars in the setting of supportive cancer care across various tumor types [2][3][4][5][6][7][8][9][10]. Herein, we expand this pharmaco-economic paradigm and report on the first cost-efficiency (and budget-neutral) expanded access simulation analysis in the setting of therapeutic monoclonal antibodies, focusing specifically on conversion from reference trastuzumab (Herceptin®, Genentech, South San Francisco, CA, USA) to biosimilar trastuzumab-dkst (Ogivri®, Viatris, Cannonsburg, PA, USA).…”

“…3 -weight patients (Table4). Conversion from trastuzumab-SC generated costsavings that ranged between $1,764,255 at a conversion rate of 10% in Q 3 -weight patients and $34,234,181 at a conversion rate of 100% in Q 1 -weight patients (Table4).…”

“…Trastuzumab dosing regimens and dosage by weight category for monotherapy and in combination with pertuzumab (and paclitaxel in cycles[1][2][3][4] …”

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

“…Previous pharmacoeconomic studies in Europe and the United States have demonstrated that the use of biosimilar G-CSF provides significant cost-savings that can be used to expand access to additional CIN/FN prophylaxis or expensive anticancer treatments on a budget-neutral basis [20][21][22][23][24][25][26] . Three studies are particularly relevant to the results reported herein, because they either estimated savings and expanded access from conversion from reference to biosimilar pegfilgrastim, or they considered the savings and access from conversion from pegfilgrastim-OBI to the biosimilar standard filgrastim under consideration of OBI device failure rates, the ensuing loss of prophylaxis, the increased risk for FN, and the incremental costs of FN-related hospitalization 20,21,25 . An ex ante simulation of conversion from reference pegfilgrastim to pegfilgrastim-bmez utilizing average sale price (ASP) and a post facto simulation utilizing wholesale acquisition cost (WAC) demonstrated the budget-neutral value of biosimilar conversion in a hypothetical panel of 20,000 patients 25 .…”