Savings With Biosimilar Filgrastim Unclear

A simulation analysis funded by Sandoz Inc is projecting cost savings or more than $40 million if their biosimilar filgrastim, known as filgrastim-sdnz (Zarxio), is used instead of the reference drug (Neupogen, Amgen) for the prevention and treatment of febrile neutropenia in breast cancer patients who are Medicare beneficiaries.

A poster of the new analysis was presented earlier this month during the San Antonio Breast Cancer Symposium (SABCS) 2018.

However, the authors of an unrelated “real-world” simulation study of the use of biosimilars for the same indication say that to date, cost savings have been “modest,” in part because of similar pricing.

This second study, from a private healthcare analytics group, was published online November 3 in JAMA Oncology.

In the first study, lead author Gary Puckrein, PhD, National Minority Quality Forum, Washington, DC, and colleagues carried out a simulation to estimate the potential out-of-pocket cost savings for Medicare patients with breast cancer who undergo treatment with filgrastim-sdnz instead of reference filgrastim.

The researchers also estimated potential savings to Medicare on payments for the administration of the same biosimilar rather than the reference drug for the treatment or prophylaxis of febrile neutropenia in beneficiaries with breast cancer.

The average out-of-pocket cost for patients and any reduction in Medicare payments per claim were then calculated for patients who received filgrastim-sdnz instead of brand-name filgrastim.

This was then extrapolated to simulate 1 million claims from 100,000 Medicare patients at an estimated 10 claims per patient.

The average cost savings per claim for each patient treated with filgrastim-sndz instead of reference filgrastim was $9.51, the researchers report.

Extrapolated to 100,000 beneficiaries — or 1 million claims — the simulation model estimated that Medicare beneficiaries would save approximately $9.6 million if they were treated with filgrastim-sndz. Medicare would see a reduction in payments of $32.9 million if the same strategy were adopted.

“It is important to understand that this is a simulation model, so further analyses of real-world patient cases are needed to more thoroughly understand the appropriate patients who should receive a filgrastim biosimilar, as well as dosing needs,” Carlos Sattler, MD, vice-president of clinical development and medical affairs at Sandoz, North America, told Medscape Medical News in an email.

“But the main message emanating from this study is that Medicare patients who were prescribed biosimilar filgrastim saved about $9.60 per claim relative to those who were prescribed reference filgrastim, and this underscores the potential value of biosimilars in saving money for patients,” he added.

More filgrastim-sndz is prescribed now in the United States than reference filgrastim, according to Sandoz.

In 2012, the total cost for treating hospitalizations for cancer-related neutropenia was $2.3 billion for adults in the United States.

More Modest

On the other hand, an investigation of the real-world safety and effectiveness of biosimilar filgrastim compared with the brand-name drug suggests that cost savings to commercially insured patients in the United States are modest.

In a retrospective observational study, Abiy Agiro, PhD, HealthCore Inc, Wilmington, Delaware, and colleagues analyzed 11,202 commercially insured adults who underwent chemotherapy and were treated with either reference filgrastim or one of two biosimilar agents — the Sandoz product, and tbo-tiligrastim (Granix, Teva) — over a period of almost 5 years.

“Patients were observed for 21 days postindex to assess filgrastim treatment cost (total and per day of use) and the incidence of FN [febrile neutropenia] and AEs [adverse events],” the researchers write.

Of this large group of patients, 13.7% were prescribed biosimilar filgrastim, they note. (The use of biosimilar filgrastim has risen steadily from 7% of filgrastim users in 2014 to 36% of users in the United States 2016.)

“Incidence rates of strict (neutropenia and fever) and broad (neutropenia or fever) definitions of FN were similar between the 2 groups,” the researchers indicate.

The cost differential between treating patients with either biosimilar compared to reference filgrastim was also not that dramatic; the mean cost of treating a single patient with any one of the three products was very similar.

Table. Treatment Costs for Biosimilar Filgrastim vs Reference Filgrastim

Biosimilar Filgrastim Tbo-Filgrastim (Granix, Teva) Filgrastim-sndz Reference Filgrastim
Mean cost per day of use $731.00 $765.00 $667.00 $748.00
Mean treatment cost per patient $2522 $2585.00 $2363.00 $2516.00

“The cost per day of use was 2.3% less for biosimilar filgrastim,” the researchers indicate. “[T]he mean total cost per patient and per day of use were 6.1% and 10.8% less for filgrastim-sndz (P = .07 and P < .001, respectively) and were marginally higher for tbo-filgrastim (2.7% and 2.3%, respectively),” they add.

Agiro and colleagues point out that savings associated with biosimilar versions of filgrastim have been modest because uptake of these agents has been slow and because current pricing for biosimilar drugs closely tracks that of the reference product.

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