Matrix45, Tucson, AZ, USA.
Medical Center, Banner University, Tucson, AZ, USA.
J Med Econ. 2020 Dec;23(12):1466-1476. doi: 10.1080/13696998.2020.1833339. Epub 2020 Oct 24.
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-needed-to-convert (NNC) to purchase one additional dose of pegfilgrastim-cbqv.
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.
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 pegfilgrastim-cbqv, 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).
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.
在本次药物经济学模拟中，我们：(1) 从美国支付方的角度，构建了将接受培非格司亭预防性治疗化疗引起的（发热性）中性粒细胞减少症（CIN/FN）的患者从参照性培非格司亭转换为生物类似药培非格司亭-cbqv 的成本效益模型；(2) 模拟了节省成本如何能够在预算中性的基础上，扩大培非格司亭-cbqv 的可及性；(3) 估算了将患者从参照性培非格司亭转换为培非格司亭-cbqv 并购买额外一剂培非格司亭-cbqv 的所需人数（NNC）。
在一个由 20,000 名患者组成的假设面板中，我们通过以下方式节约成本：两种参照制剂（预充式注射器[PFS]和体部注射装置[OBI]）、三种药物成本输入（平均销售价格[ASP]、批发采购成本[WAC]和年龄比例混合 ASP/WAC 率）、PFS 的注射和 OBI 的装置应用的管理成本、10%-100%的转换率和 1-6 个周期的预防治疗。节省的成本用于估计可购买的额外剂量的培非格司亭-cbqv，并估算购买额外一剂培非格司亭-cbqv 的 NNC。
使用 ASP 和从参照性 OBI 至培非格司亭-cbqv 的 10%转换率，节省金额从 326,744 美元（1 个周期）至 2000 万美元（6 个周期）不等，这分别可提供 93-556 剂额外的培非格司亭-cbqv；购买额外一剂培非格司亭-cbqv 的 NNC 从 21.6（1 个周期）到 3.6 名患者（6 个周期）不等。WAC 模型在 100%参照性 PFS 转换的情况下，每个周期节省 4110 万美元，6 个周期节省 2.467 亿美元，可提供 9709-58253 剂额外的培非格司亭-cbqv；NNC 从 2.1（1 个周期）到 0.3（6 个周期）不等。使用混合 ASP/WAC 率，将 50%的参照性 OBI 转换为培非格司亭-cbqv，每个周期可节省 1020 万美元，6 个周期可节省 6090 万美元，可提供 2638-15829 剂额外的培非格司亭-cbqv；NNC 为 3.8（1 个周期）和 0.6 名患者（6 个周期）。
将 20,000 名患者在 6 个周期内从参照性培非格司亭转换为培非格司亭-cbqv，可产生高达 2.467 亿美元的节省，足以购买多达 58253 剂额外的培非格司亭-cbqv。本次模拟为使用生物类似药培非格司亭-cbqv 进行预防性治疗提供了经济学依据。
