Cost-Savings from Conversion to Biosimilar Pegfilgrastim-cbqv Providing Expanded Access to Prophylaxis and Antineoplastic Therapy in NHL

Simulation-modeling data indicate significant cost-savings may be generated by converting from reference pegfilgrastim ± on-body injector to biosimilar pegfilgrastim-cbqv for prophylaxis of chemotherapy-induced (febrile) neutropenia in patients with non-Hodgkin lymphoma (NHL).

Cost-savings achieved by converting from reference pegfilgrastim (PEG) with or without on-body injector (OBI) to its biosimilar pegfilgrastim-cbqv (PEG-cbqv) for the prophylaxis of chemotherapy-induced neutropenia (CIN)/febrile neutropenia (FN) may create opportunities for reallocation of the savings toward providing additional CIN/FN prophylaxis with PEG-cbqv or immunochemotherapy with rituximab + cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). To test this hypothesis, simulation modeling of cost-efficiency and expanded access was conducted in a large hypothetical cohort of patients with non-Hodgkin lymphoma (NHL); the results of this analysis were reported at the 62nd American Society of Hematology Annual Meeting and Exposition.

A total of 20,000 hypothetical patients with NHL who received 1 to 6 cycles of R-CHOP were included in the analysis. Conversion rates from PEG/PEG-OBI to PEG-cbqv ranging from 10% to 100% were analyzed in the model. In regard to medication costs, 3 cost-estimate bases were used for the 3 drugs (PEG/PEG-OBI, pegfilgrastim-cbqv, and R-CHOP): using second-quarter 2020 average sales price (ASP) derived from Centers for Medicare & Medicaid Services fourth-quarter 2020 reimbursement limits; wholesale acquisition cost (WAC) from the Red Book database; and a blended ASP/WAC rate proportionate to the NHL age distribution per Surveillance, Epidemiology, and End Results Program data. In addition, the number needed to convert from PEG/PEG-OBI to PEG-cbqv in order to purchase 1 additional dose of PEG-cbqv or 1 additional cycle of R-CHOP chemotherapy was calculated.

Using ASP, cost-savings from conversion from PEG/PEG-OBI to PEG-cbqv ranged from $2.6 million (for 1 cycle of prophylaxis at 10% conversion) to $15.8 million (for 6 cycles at 100% conversion). For 6 cycles at 100% conversion, the cost-savings using WAC was $246.7 million, whereas cost-savings using the blended ASP/WAC rate was $114.9 million; the blended rate per-patient savings was $5743.

Using the blended ASP/WAC rate, the number needed to convert to purchase 1 additional cycle of PEG-cbqv from 1 cycle of conversion was 3.84, and across 6 cycles of conversion was 0.64. The conversion savings from a single cycle of R-CHOP would allow the purchase of additional PEG-cbqv, ranging from 521 cycles at 10% conversion to 5214 cycles at 100% conversion; across 6 cycles, it allowed for the purchase of 3129 additional cycles at 10% conversion and 31,287 cycles at 100% conversion. Similarly, conversion savings using blended ASP/WAC rate from a single cycle of chemotherapy would provide expanded access to additional cycles of R-CHOP, ranging from 276 cycles at 10% conversion to 2755 cycles at 100% conversion, which across 6 cycles exponentially increased to 1653 cycles (at 10% conversion) and 16,533 cycles (at 100% conversion). 

These simulation models show significant cost-savings achieved through conversion from PEG/PEG-OBI to biosimilar PEG-cbqv for CIN/FN prophylaxis in patients with NHL receiving standard R-CHOP chemotherapy, which could potentially be reallocated to provide expanded access to additional cycles of PEG-cbqv or additional cycles of R-CHOP therapy in these patients.

Reference
McBride A, et al. ASH 2020. Abstract 3425.