The results of the cost-efficiency analysis within the Centers for Medicare & Medicaid Services Oncology Care Model indicate that switching from reference pegfilgrastim to pegfilgrastim-jmdb provided cost-savings that could potentially be reallocated to food and transportation support.
Using the Centers for Medicare & Medicaid Services Oncology Care Model, researchers analyzed potential cost-efficiency gains from switching selected patients with cancer from reference pegfilgrastim to its biosimilar (pegfilgrastim-jmdb) and simulated reallocating the savings gained to provide nutrition and transportation support to Centers for Medicare & Medicaid Services beneficiaries.
The Surveillance, Epidemiology, and End Results database was used to extract incidence rates for breast, ovarian, lung, and colorectal cancers and non-Hodgkin lymphoma, with stratification by age <65 years (commercial insurance) or >65 years (Medicare). It was assumed that 19.4% of chemotherapy (tumor type-matched) would require pegfilgrastim prophylaxis. Two models compared prefilled syringe and on-body injector pegfilgrastim reference to prefilled syringe pegfilgrastim-jmdb. Cost inputs included Average Sales Price 3Q20 for Medicare and National Average Drug Acquisition Cost for Medicaid patients, plus medication administration.
In 2020, it was estimated that 31,210 Medicare and 1722 Medicaid patients in the 5 tumor types required pegfilgrastim prophylaxis. Switching pegfilgrastim to pegfilgrastim-jmdb in these patients provided estimated cost-savings of up to approximately $19 million (Medicare) and approximately $20 million (Medicaid). Using simulation models, these cost-savings translated to a monthly $100 food or transportation check to at least 24,716 Medicare or 33,630 Medicaid patients for 6 months.
Based on the results of the cost-efficiency analyses, the authors concluded that switching to a biosimilar afforded cost-savings that could potentially be reallocated on a budget-neutral basis to food and transportation support.
Source: Macdonald K, Al Rawashdh N, McBride A, et al. Cost-efficiency analysis of conversion from reference pegfilgrastim to its biosimilar (pegfilgrastim-jmdb) and expanded access to food and transportation support for Medicare/Medicaid patients within the CMS Oncology Care Model. J Clin Oncol. 2021;39(suppl_15):e18837.