February 2017 Vol 10, Special Issue: Payers’ Perspectives In Oncology: ASH 2016 Highlights - Value-Based Care
Chase Doyle

San Diego, CA—Filgrastim (Neupogen), a short-acting granulocyte colony-stimulating factor (G-CSF), has helped to manage chemotherapy-induced neutropenia in patients with nonmyeloid malignancies, but it comes with a hefty price tag. According to a recent study, biosimilars of filgrastim may provide a more affordable option for US payers, suggested Susan Gabriel, Director of Global Health Economics and Outcomes Research, Teva Pharmaceuticals, Frazer, PA, at the 2016 American Society of Hematology meeting.

The results of the budget impact analysis presented at the meeting showed that increasing the utilization of the biosimilars filgrastim-sndz (Zarxio) and tbo-filgrastim (Granix) could save millions of dollars for the US healthcare system. These 2 biosimilars to filgrastim have comparable efficacy and safety to the reference drug.

“The present analysis estimated an annual US health plan cost-savings approaching $2 million overall or almost $2 per-member per-year, following an increase of market share by approximately 5% for tbo-filgrastim and 2% for filgrastim-sndz,” said Ms Gabriel.

Neutropenia is a common complication in patients who receive myelosuppressive chemotherapy, which can lead to prolonged hospitalization, serious infections, and increased mortality. Short-acting G-CSFs have been shown to reduce the incidence, severity, and duration of chemotherapy-­induced neutropenia.

Budget Impact Analysis

Ms Gabriel and colleagues developed a budget impact model to estimate the changes in drug and administration costs for a 1-million-member health plan. Among patients who received short-acting G-CSF treatment, it was assumed that the treatment was administered by a healthcare provider in 80% of those patients. In addition, 85% of drugs were assumed to be adjudicated through the patient’s medical benefit, and the remaining 15% were purchased through the patient’s pharmacy benefit.

“We made the assumption that filgrastim would lose 7% market share over a 1-year period. We projected that 5% of that would go to tbo-filgrastim and 2% to filgrastim-sndz, which was just recently launched last year,” she added.

Based on the use of 60 doses of tbo-filgrastim annually (10 days per cycle and 6 cycles yearly), the effective annual per-patient drug cost totaled between $11,904 and $19,047 (in medical benefit) or $16,961 and $27,199 (in pharmacy benefit), depending on the dosage and packaging instructions.

For filgrastim-sndz, the annual per-patient drug cost was between $15,418 and $24,669 (in medical benefit) or $16,216 and $26,015 (in pharmacy benefit).

For filgrastim, the annual per-patient drug cost was between $15,573 and $24,917 (in medical benefit) or $18,034 and $30,663 (in pharmacy benefit).

The use of short-acting G-CSFs was associated with an estimated overall annual plan cost of $177,151,918 in the current scenario and $175,230,446 in the future scenario. The estimated annual cost-savings totaled $1,921,473.

The model was most sensitive to changes in the overall proportion of patients with healthcare provider–administered G-CSFs and the average sales price per-dose cost for filgrastim.

The majority of healthcare provider–administered short-acting G-CSFs are adjudicated through the medical benefit, where the annual plan per-­patient drug cost was lowest for tbo-­filgrastim and 24% lower than filgrastim, said Ms Gabriel.

For short-acting G-CSFs that were adjudicated through the pharmacy benefit, the annual plan per-patient drug cost was lowest for filgrastim-sndz and 15% lower than filgrastim.

“Based on these assumptions, a million-member health plan could save almost $2 million per year by switching over to tbo-filgrastim as opposed to filgrastim or filgrastim-sndz,” Ms Gabriel said. “However, as with any budget impact model, estimated results based on future product market share should be interpreted cautiously,” she emphasized.

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