Abstract P4-12-07: Cost-minimization of chemotherapy-induced (febrile) neutropenia prophylaxis with biosimilar ZARXIO® over NEUPOGEN®, NEULASTA®, and NEULASTA/ONPRO®: Breast cancer case study
Authors: McBride A , Campbell K , Bikkina M , MacDonald K , Abraham I , Balu S 
Published: February 2018

Abstract
RATIONALE & OBJECTIVES: Biosimilar filgrastim may offer significant cost advantages over originator filgrastim and pegfilgrastim. The objectives were (1) to evaluate for the US the comparative cost-minimization of chemotherapy-induced (febrile) neutropenia (CIN/FN) prophylaxis with biosimilar filgrastim ZARZIO® over originator filgrastim NEUPOGEN®, and originator pegfilgrastim NEULASTA® and NEULASTA/ONPRO® injection device with the health-care provider (HP) providing full administration, using 3Q2016 average selling price (ASP); and (2) to apply the different savings estimates to a breast cancer case study.
METHODS: Cost-minimization analysis of [1] acquisition costs for one patient for one chemotherapy cycle for 1 to 14 days (d) using per unit dose, and [2] administration costs using Current Procedural Terminology (CPT) codes. We calculated [1] the general cost of prophylaxis for one cycle with each agent, with standard filgrastim administrations ranging from 1-14 days and pegfilgrastim limited to single administration; and [2] the cost-savings that could be accrued from 1-14d prophylaxis with ZARXIO® over the three originator options. The case study concerns a 43 y/o Caucasian female, newly diagnosed with stage 2 HER2-negative breast cancer being started on TAC (FN risk &gt;20%); unremarkable medical history; no comorbidities; with primary prophylaxis initiated in cycle 1 and continued through 6 cycles per local protocol (single NEULASTA® or NEULASTA/ONPRO® or 11d NEUPOGEN® or ZARXIO®).
RESULTS: Using ASP+CPT, prophylaxis cost per dose (rounded) was $260 for ZARXIO®, $326 for NEUPOGEN®, $3,926 for NEULASTA®; $3,910 for NEULASTA®. In general, cost-savings per cycle from ZARXIO® over NEUPOGEN® ranged from $65 (1d) to $916 (14d); over Neulasta®, from $3,666 (1d) to $284 (14d); and over NEULASTA/ONPRO®, from $3,649 (1d) to $267 (14d). In the breast cancer case study, cost of prophylaxis per one cycle was $2,862 for ZARXIO® (11d), $3,582 for NEUPOGEN® (11d) vs. $3926 for NEULASTA® and $3910 for NEULASTA/ONPRO® single-injection. Cost-savings per cycle from ZARXIO® use were $719 vs. NEUPOGEN®, $1,064 vs. NEULASTA®, and $1,047 vs. NEULASTA/ONPRO®. Total savings from ZARXIO® use over all 6 TAC cycles were $4,316 vs. NEUPOGEN®, $6,385 vs. NEULASTA®, and $6,284 vs. NEULASTA/ONPRO®.
CONCLUSIONS: In general, CIN/FN prophylaxis with ZARXIO® for 1-14d generates significant cost savings over NEUPOGEN®, NEULASTA® and NEULASTA/ONPRO generating significant cost-savings. In the case study of the 43 y/o HER-negative breast cancer patient treated with TAC and prescribed 6 cycles of primary prophylaxis with 11d standard or single-administration pegfilgrastim, savings reached as high as $6,385 for the full course of chemotherapy. Given the trial evidence of non-inferiority of pegfilgrastim over filgrastim, the clinical trend for &lt;14d of filgrastim prophylaxis, and payer trends to authorize filgrastim vs. pegfilgrastim prophylaxis, using biosimilar Zarxio® is rational from both a economic perspective; as illustrated also in the breast cancer case study.
Citation Format: McBride A, Campbell K, Bikkina M, MacDonald K, Abraham I, Balu S. Cost-minimization of chemotherapy-induced (febrile) neutropenia prophylaxis with biosimilar ZARXIO® over NEUPOGEN®, NEULASTA®, and NEULASTA/ONPRO®: Breast cancer case study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-12-07.