The University of Arizona Cancer Center, Tucson, AZ, USA.
Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy, Tucson, AZ, USA.
J Med Econ. 2021 Jan-Dec;24(1):598-606. doi: 10.1080/13696998.2021.1916863.
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.
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.
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).
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.
治疗指南建议预防化疗引起的（发热性）中性粒细胞减少症（CIN/FN）。培非格司亭（Neulasta）、培非格司亭生物类似药（pegfilgrastim-jmdb，Fulphila）和带有体部注射装置的培非格司亭（OBI；Neulasta Onpro）是 CIN/FN 预防的选择。我们旨在通过从培非格司亭-OBI 转换为 pegfilgrastim-jmdb 来模拟成本节约和预算平衡，扩大 CIN/FN 预防或抗癌治疗的机会，并评估由于培非格司亭-OBI 失败导致的中性粒细胞减少症相关住院费用的经济影响。
从培非格司亭-OBI 转换为生物类似药 pegfilgrastim-jmdb 的成本节约从美国支付者的角度在 15000 名癌症患者的小组中进行了模拟。主要分析包括 10%至 100%的转换率。调整分析还考虑了 OBI 设备故障率为 1%至 7%以及与中性粒细胞减少症相关的住院治疗相关的成本。还对 pegfilgrastim-jmdb 或利妥昔单抗、环磷酰胺、多柔比星、长春新碱和泼尼松（R-CHOP）用于弥漫性大 B 细胞淋巴瘤（DLBCL）的预算中性扩展预防进行了模拟。
在 15000 名患者的小组中，在单个周期中，从 pegfilgrastim-OBI 转换为 pegfilgrastim-jmdb 的成本节约范围从 481259 美元（10%转换）到 4812585 美元（100%转换）。在 6 个周期的 100%转换中，节省了 28857510 美元，并可向 9191 名患者提供额外剂量的 pegfilgrastim-jmdb 或 4463 个周期的 R-CHOP。调整 OBI 故障后，6 个周期的成本节约范围从 2935565 美元（10%转换；pegfilgrastim-OBI 故障率为 1%）到 32236499 美元（100%转换；7%故障）。这些节省的成本可提供 943 剂 pegfilgrastim-jmdb 或 454 剂 R-CHOP（10%转换；pegfilgrastim-OBI 失败率为 1%），或提供 10261 剂 pegfilgrastim-jmdb 或 4982 个周期的 R-CHOP（100%转换；7%失败）。
从培非格司亭转换为 pegfilgrastim-jmdb 可显著降低成本，当同时考虑到 pegfilgrastim-OBI 故障和相关的中性粒细胞减少症相关住院治疗时，成本节约幅度会显著增加。这些一般性和故障相关的成本节约可以在预算中性的基础上进行分配，以向更多的患者提供额外的 CIN/FN 预防或抗癌治疗。
