Primary Prophylaxis With Biosimilar of Filgrastim Appears to be a Cost Effective Option for Individuals at Intermediate Risk of Febrile Neutropenia


Investigators theorize that a filgrastim-sndz biosimilar is an affordable option for patients across a number of tumor types who are undergoing curative intent treatment with chemotherapy and have an intermediate risk for experiencing febrile neutropenia.

A biosimilar of filgrastim-sndz has been identified as a cost-effective option for the treatment of patients who are undergoing curative treatment with chemotherapy at an intermediate risk of developing febrile neutropenia across several tumor types, according to a study published in JCO Oncology Practice.

Results from the study, which included patients with breast cancer, non–small cell lung cancer (NSCLC), and non-Hodgkin lymphoma (NHL), found that the filgrastim biosimilar added an additional 0.102 and 0.144 life years and 0.065 to 0.130 quality-adjusted life years at an incremental cost that ranged from $650 to $2463. Additionally, investigators noted that the incremental cost-effectiveness ratios ranged from $5660 to $20,806 per febrile neutropenia event avoided, as well as $5123 to $31,077 for life years gained and $7213 to $35,563 per quality-adjusted life years gained. NSCLC notably had the lowest incremental cost-effectiveness ratios.

“In the era of COVID-19 and value-based care, the use of biosimilar filgrastim has valuable potential to reduce complications associated with unnecessary contact with the health care system among patients undergoing potentially curative chemotherapy. This analysis supports the expanded use of PP with biosimilar filgrastim and should be more strongly considered, if not recommended, by patients and providers to improve long-term outcomes,” the investigators wrote.

Investigators built off prior febrile neutropenia cost-effectiveness analyses and utilized a Markov cycle free-based model to assess the cost-effectiveness of primary prophylaxis compared with secondary prophylaxis. This helped to evaluate colony-stimulating factor (CSF) prophylaxis in conjunction with standard intermediate-risk chemotherapy regimens, including adjuvant docetaxel in breast cancer; adjuvant carboplatin and paclitaxel in NSCLC; and rituximab (Rituxan), cyclophosphamide, doxorubicin, vincristine, and prednisone in NHL.

Additionally, a one-way sensitivity analysis assessed data regarding the cost per quality-adjusted life years gained for breast cancer, baseline febrile neutropenia risk, mortality hazard ratio for low relative dose intensity, and the relative risk of febrile neutropenia with the biosimilar compared with no CSF prophylaxis. Notably, for patients with NSCLC and NHL, the parameters that had the greatest influence were febrile neutropenia risk, mean length of hospitalization, and the cost of febrile neutropenia that resulted in hospitalization.

After adjusting the baseline febrile neutropenia risk to 10% or 20% for the breast cancer model, investigators reported results that ranged from $86,573 to $18,995 per quality-adjusted life years gained, respectively. After applying similar adjustments to the NSCLC model, the results ranged from $53,670 to $1467 per quality-adjusted life years gained. Finally, in the NHL model, investigators reported findings that ranged from $67,238 to $12,884 per quality-adjusted life years gained.

Additional findings that saw the adjustment of the average sale price of filgrastim-sndz by 90% to 110% at baseline yielded less of an impact on the model results compared with baseline febrile neutropenia risk. The results per quality-adjusted years gained included $30,056 to $41,070, $3250 to $11,177, and $14,593 to $23,349 in the breast cancer, NSCLC, and NHL models, respectively.

“Especially in the current environment where value for money is an urgent focus of providers, governments, and manufacturers, the expanded use of PP also has the potential to contribute to value-based care. In 2016, the Centers for Medicare & Medicaid Services launched the OCM, a system that incentivizes practice advancements and value-based care in oncology,” the study’s investigators concluded.


Li E, Mezzio DJ, Campbell D, et al. Primary prophylaxis with biosimilar filgrastim for patients at intermediate risk for febrile neutropenia: a cost-effectiveness analysis. JCO Oncol Prac. 2021;17(8):e1235-e1245. doi:10.1200/OP.20.01047

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