The findings of a simulation modeling analysis demonstrate that conversion from pegfilgrastim with on-body injector to pegfilgrastim-jmdb provides significant cost-savings, which could be reallocated on a budget-neutral basis to provide expanded access to additional prophylaxis or to antineoplastic therapy in patients with diffuse large B-cell lymphoma.
For the prophylaxis of chemotherapy-induced (febrile) neutropenia (CIN/FN), 3 options are currently available: pegfilgrastim, pegfilgrastim with on-body injector (OBI), and its biosimilar pegfilgrastim-jmdb. A simulation modeling was performed to: (1) demonstrate that cost-savings generated from conversion of pegfilgrastim-OBI to pegfilgrastim-jmdb could be reallocated on a budget-neutral basis to provide expanded access to additional prophylaxis or to antineoplastic therapy and (2) to evaluate the economic impact of FN-related hospitalization costs due to pegfilgrastim-OBI failure.
A panel of 15,000 patients with cancer was used in the simulation modeling from the US payer perspective. The primary analyses included conversion rates of 10% to 100%. Simulations of budget-neutral expanded access to prophylaxis with pegfilgrastim-jmdb or to anticancer treatment of rituximab plus cyclophosphamide/doxorubicin/vincristine/prednisone (R-CHOP) for diffuse large B-cell lymphoma (DLBCL) were also performed. Adjusted analyses assumed OBI device failure rates of 1% to 7% and associated costs of FN-related hospitalization.
In a single cycle, the modeling showed that conversion from pegfilgrastim-OBI to pegfilgrastim-jmdb resulted in cost-savings ranging from $481,259 (10% conversion) to $4,812,585 (100% conversion). When modeled for 6 cycles at 100% conversion, the cost-savings were $28,857,510, which could be reallocated to provide 9191 additional doses of pegfilgrastim-jmdb or 4463 cycles of R-CHOP to patients with DLBCL.
The cost-savings further increased when adjusted for OBI failure and FN-related hospitalizations. Over 6 cycles, cost-savings ranged from $2,935,565 (10% conversion; 1% pegfilgrastim-OBI failure rate) to $32,236,499 (100% conversion; 7% pegfilgrastim-OBI failure rate). These cost-savings could provide expanded access to 943 doses of pegfilgrastim-jmdb or 454 doses of R-CHOP (10% conversion; 1% pegfilgrastim-OBI failure rate) or provide 10,261 doses of pegfilgrastim-jmdb or 4982 cycles of R-CHOP (100% conversion; 7% pegfilgrastim-OBI failure rate).
The findings of the simulation modeling support the conversion from pegfilgrastim to pegfilgrastim-jmdb to derive significant cost-savings, which is exponentially increased when pegfilgrastim-OBI failure and associated FN-related hospitalizations are also taken into account. The modeling also demonstrates that these cost-savings could be allocated on a budget-neutral basis to provide additional CIN/FN prophylaxis or antineoplastic treatment to more patients with DLBCL.
Source: McBride A, MacDonald K, Fuentes-Alburo A, Abraham I. Conversion from pegfilgrastim with on-body injector to pegfilgrastim-jmdb: cost-efficiency analysis and budget-neutral expanded access to prophylaxis and treatment. J Med Econ. 2021;24:598-606