Simulation-modeling data demonstrate significant cost-savings by converting from reference pegfilgrastim with on-body injector to biosimilar pegfilgrastim-jmdb for prophylaxis of chemotherapy-induced neutropenia/febrile neutropenia in patients with diffuse large B-cell lymphoma (DLBCL).
Reference pegfilgrastim with on-body injector (PEG-OBI) is more convenient than use of next-day prefilled syringes for the prophylaxis of chemotherapy-induced neutropenia (CIN)/febrile neutropenia (FN); however, the failure rate of PEG-OBI is in the range of 1.7% to 6.9%, which increases the risk for CIN/FN episodes and resultant FN-related hospitalizations. In this context, significant cost-savings may be achieved by converting from reference PEG-OBI to its biosimilar pegfilgrastim-jmdb (PEG-jmdb) administered using a next-day prefilled syringe that provides assured prophylaxis for CIN/FN. These cost-savings generated from assured prophylaxis with biosimilar PEG-jmdb may be reallocated to provide additional CIN/FN prophylaxis with PEG-jmdb or additional cycles of immunochemotherapy with rituximab + cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). To test these hypotheses, simulation modeling of cost-efficiency and expanded access was conducted in a large hypothetical cohort of patients with diffuse large B-cell lymphoma (DLBCL); results of these analyses were reported at the 62nd American Society of Hematology Annual Meeting and Exposition.
A panel of 15,000 hypothetical patients with DLBCL who received 1 to 6 cycles of R-CHOP and were at increased risk for CIN/FN were included in the simulation modeling. Conversion rates from reference PEG-OBI to biosimilar PEG-jmdb that were used in the analysis ranged from 10% to 100%. Medication costs were based on second-quarter 2020 average sales price derived from the Centers for Medicare & Medicaid Services (CMS) fourth-quarter 2020 reimbursement limits. The administration costs of PEG-OBI and PEG-jmdb were derived from the CMS Outpatient Prospective Payment System. Reported PEG-OBI failure rates of 1% to 7% were utilized in the model. Based on published data, a 10.03% differential base rate of FN-related hospitalizations in non-Hodgkin lymphoma (NHL) over a 6-cycle regimen was used; the rate of FN-related hospitalizations was calculated as the rate without colony-stimulating factor (CSF) minus the rate with CSF.
For prophylaxis in 1 cycle of chemotherapy in a panel of 15,000 patients with DLBCL, cost-savings from conversion to PEG-jmdb ranged from $481,259 at 10% conversion to $4.8 million at 100% conversion, including cost of medication plus administration. Across 6 cycles of chemotherapy, cost-savings from conversion to PEG-jmdb ranged from $2.8 million at 10% conversion to $28.8 million at 100% conversion. These cost-savings may provide budget-neutral expanded access to purchase additional cycles of PEG-jmdb, 153 cycles (1 cycle at 10% conversion) and 9191 cycles (6 cycles at 100%). Alternatively, a minimum of 74 additional cycles of R-CHOP (1 cycle at 10% conversion) and a maximum of 4463 cycles (6 cycles at 100%) may also be purchased with the cost-savings.
Adjusting for PEG-OBI failures and associated hospitalization costs, cost-savings translated into expanded access to 15 additional cycles of PEG-jmdb or 7 cycles of R-CHOP (at 10% conversion and 1% PEG-OBI failure) and 1070 cycles of PEG-jmdb or 519 cycles of R-CHOP (at 100% conversion and 7% PEG-OBI failure).
These simulation models show significant cost-savings achieved through conversion from PEG-OBI to biosimilar PEG-jmdb for CIN/FN prophylaxis in patients with DLBCL when considering drug and administration costs. Additional cost-savings were achieved when the costs of FN-related hospitalizations related to PEG-OBI failure were taken into account. These cost-savings may potentially be reallocated to provide expanded access to additional cycles of PEG-jmdb or additional cycles of R-CHOP therapy.
McBride A, et al. ASH 2020. Abstract 3422.