Budget Impact Analysis of Treating Chemotherapy Patients with Health Care Provider-Administered Tbo-Filgrastim, Filgrastim-Sndz, and Filgrastim in the United States
Authors: Trautman Holly , Szabo Erika , Lo-Coco Francesco , James Elizabeth , Gabriel Susan , Zhou Jifang , Pathak Ashutosh , Tang Boxiong 
Published: October 2019

Abstract
Introduction: Granulocyte colony-stimulating factors (G-CSFs) are often administered to reduce the incidence, severity, and duration of febrile neutropenia in chemotherapy patients. Tbo-filgrastim and filgrastim-sndz are short-acting G-CSFs with comparable efficacy and safety to that of filgrastim. The present analysis estimated the budget impact of increasing utilization of health care provider (HCP)-administered tbo-filgrastim and filgrastim-sndz on patients with nonmyeloid malignancies treated with myelosuppressive chemotherapy from a US payer perspective.
Methods: An interactive budget impact model was developed to estimate the changes in drug and administration costs for a 1 million member health plan. Administration by an HCP (within a clinic or other outpatient setting) was assumed for 80% of patients receiving short-acting G-CSF treatment, with the majority (85%) of products adjudicated through the patient's medical benefit/provided by the HCP and the remaining 15% purchased through the patient's pharmacy benefit. For medical benefit adjudication, the model projected increases in the market share of tbo-filgrastim from 37% to 42% and filgrastim-sndz from 2% to 4% (with a decrease in filgrastim market share from 61% to 54%). For pharmacy benefit adjudication, the model projected increases in the market share of tbo-filgrastim from <1% to 2% and filgrastim-sndz from 5% to 7% (with a decrease in filgrastim market share from 95% to 91%). Base case data were derived from publicly available resources. The overall plan budget impact was calculated using a 1-year time horizon, along with the difference in per-member per-year (PMPY) cost between the current and future scenarios; one-way sensitivity analyses were conducted.
Results: The effective annual plan per-patient drug cost totaled between $11,904 and $27,199, depending on dose, presentation, and benefit adjudication, for tbo-filgrastim, between $15,418 and $26,015 for filgrastim-sndz, and between $15,573 and $30,663 for filgrastim. The estimated overall annual plan cost associated with HCP-administered short-acting G-CSFs was $177,151,918 (PMPY = $177.15) in the current scenario and $175,230,445 (PMPY = $175.23) in the future scenario. Cost savings totaled $1,921,473 (PMPY = $1.92). The model was most sensitive to changes in the overall proportion of patients with HCP-administered G-CSFs and to HCP filgrastim acquisition cost.
Conclusions: Budget impact analyses examine the financial impact associated with the introduction of new treatments or shifting existing treatment patterns in order to help decision makers determine how best to allocate resources. The majority of HCP-administered G-CSF is adjudicated through the medical benefit, where the effective annual plan per-patient drug cost was lowest for tbo-filgrastim (24% lower cost than filgrastim). For the remainder of HCP-administered G-CSF adjudicated through the pharmacy benefit, the effective annual plan per-patient drug cost was lowest for filgrastim-sndz (15% lower cost than filgrastim). The present analysis estimated an annual US health plan cost savings approaching $2 million overall or almost $2.00 PMPY following an increase of market share by approximately 5% for tbo-filgrastim and 2% for filgrastim-sndz.

Disclosures
Trautman: Teva Pharmaceuticals, Inc.: Consultancy. Szabo:Patient Centered Outcomes Research (PCORI): Consultancy; Teva Pharmaceuticals, Inc.: Employment; Eli Lilly & Company; Zoetis: Equity Ownership. Lo-Coco:Teva, Novartis, Baxalta, Pfizer: Consultancy; Teva, Lundbeck: Honoraria, Speakers Bureau. James:Teva Pharmaceuticals, Inc.: Consultancy. Gabriel:Teva Pharmaceuticals, Inc.: Employment. Pathak:Teva Pharmaceuticals: Employment, Equity Ownership. Tang:Teva Pharmaceuticals, Inc.: Employment.