Cost simulation for the US of febrile neutropenia hospitalization due to pegfilgrastim on-body injector failure compared to single-injection pegfil...

Date 24 November 2018
Event ESMO Asia 2018 Congress
Session Poster display - Cocktail
Topics Supportive Measures
Bioethics, Legal, and Economic Issues
Thoracic Malignancies
Presenter Ali McBride
Citation Annals of Oncology (2018) 29 (suppl_9): ix129-ix138. 10.1093/annonc/mdy444
Authors A. McBride1, A. Krendyukov2, N. Mathieson3, K. Campbell4, S. Balu4, K. MacDonald5, I. Abraham6
  • 1College Of Pharmacy, University of Arizona Cancer Center, 85719 - Tucson/US
  • 2Medical Oncology/hematology, Hexal AG, 83607 - Holzkirchen/DE
  • 3Hematology/nephrology, Hexal AG, Holzkirchen/DE
  • 4Medical Affairs, Sandoz Inc., 08540 - Princeton/US
  • 5Analytics, Matrix45, 85743 - Tucson/US
  • 6College Of Pharmacy, University of Arizona, 85721 - Tucson/US

Abstract

Background

Failures of pegfilgrastim on-body injector (PEG-OBI) have been reported. Such failures may increase the risk of chemotherapy-induced febrile neutropenia (FN) beyond rates associated with single-injection pegfilgrastim (PEG) and daily injections with reference (REF-FIL) or Sandoz filgrastim biosimilar (BIOSIM-FIL) and increase the likelihood of FN-related complications, including hospitalizations (FN-HOSP). We aimed to estimate for the US the incremental costs of FN-HOSP associated with failures of PEG-OBI compared to prophylaxis with PEG and various scenarios of daily injections of REF-FIL and BIOSIM-FIL in the lung cancer setting.

Methods

Simulation analysis from a US payer perspective of incremental hospital costs associated with PEG-OBI failure rates of 1-10% compared to costs of assured prophylaxis with PEG, REF-FIL, and BIOSIM-FIL for cycle 1 for a panel of 10,000 lung cancer patients. Filgrastim regimens included real-world durations of 4.3 & 5 days and standard 11 days. Costs (US$) were based on 1Q2018 average selling price for drugs and CPT reimbursement for administration. Incremental risk of FN-HOSP was extrapolated from Timmer-Bonte et al. (JCO 2005) small cell lung cancer trial data. FN-HOSP costs in lung/bronchus cancer (Tai et al. JOP 2017) were adjusted to 2018 per Bureau of Labor Statistics Consumer Price Index for Medical Care.

Results

Incremental costs attributable to varying PEG-OBI failure rates compared to costs for other GCSFs for cycle 1 for a panel of 10,000 lung cancer patients are listed in the table.Table: 437P

Incremental cycle 1 costs attributable to PEG-OBI failure

PEG-OBI vs REF-FILPEG-OBI vs REF-FILPEG-OBI vs REF-FILPEG-OBI vs BIOSIM-FILPEG-OBI vs BIOSIM-FILPEG-OBI vs BIOSIM-FIL
Failure ratePEG-OBI vs PEG4.3 days5 days11 days4.3 days5 days11 days
0.01$(175,931)$29,989,879$27,555,769$6,691,969$34,762,879$33,105,769$18,901,969
0.02$21,338$30,187,148$27,753,038$6,889,238$34,960,148$33,303,038$19,099,238
0.03$218,607$30,384,417$27,950,307$7,086,507$35,157,417$33,500,307$19,296,507
0.04$415,876$30,581,686$28,147,576$7,283,776$35,354,686$33,697,576$19,493,776
0.05$613,144$30,778,954$28,344,844$7,481,044$35,551,954$33,894,844$19,691,044
0.06$810,413$30,976,223$28,542,113$7,678,313$35,749,223$34,092,113$19,888,313
0.07$1,007,682$31,173,492$28,739,382$7,875,582$35,946,492$34,289,382$20,085,582
0.08$1,204,951$31,370,761$28,936,651$8,072,851$36,143,761$34,486,651$20,282,851
0.09$1,402,220$31,568,030$29,133,920$8,270,120$36,341,030$34,683,920$20,480,120
0.10$1,599,489$31,765,299$29,331,189$8,467,389.$36,538,299$34,881,189$20,677,389

Conclusions

The incremental costs of FN-HOSP due to PEG-OBI failure in cycle 1 in a panel of 10,000 lung cancer patients compared to other GCSFs vary depending on failure rate and comparator GCSF. Incremental costs due to PEG-OBI failure are lowest versus PEG and highest versus BIOSIM-FIL and real-world duration of 4.3 days.

Editorial acknowledgement

Clinical trial identification

Legal entity responsible for the study

Hexal AG.

Funding

Hexal AG.

Disclosure

A. McBride: Speakers bureau, steering committee: Sandoz Inc. A. Krendyukov, N. Mathieson: Employee: Hexal AG. K. Campbell, S. Balu: Employee: Sandoz Inc. K. MacDonald, I. Abraham: Employee: Matrix45, which was contracted by Hexal AG to conduct the simulations. Company policy prohibits employees from owning equity in client organizations. Matrix45 provides services on a non-exclusivity basis.