Febrile neutropenia poses complex clinical and economic challenges

Neutropenia can result in a reduced dose, delay, or discontinuation of chemotherapy1

Every year in the United States, it is estimated that more than

60,000 patients

with cancer are hospitalized for neutropenia2

pending

Every year in the United States, it is estimated that more than

60,000 patients

with cancer are hospitalized for neutropenia2

pending
  • $24,770
    is the mean cost of hospitalization stay for adults (with an average stay of 9.6 days)2
pending
  • ~1 in 14 patients*
    will die from febrile neutropenia2
  • Patients undergoing chemotherapy who develop neutropenia face significant medical costs1
*Patients hospitalized for febrile neutropenia.
pending

Treating life-threatening, chemotherapy-induced neutropenia increases the clinical burden on both healthcare professionals and patients1

Use of a long-acting G-CSF biosimilar may offset the increased costs of hospitalization3-5

  • The introduction of more long-acting G-CSF biosimilars may drive down treatment costs, thereby potentially increasing availability and access for patients3-7
pending
  • Congressional Budget Office estimates show the sales-weighted market average discount on biosimilars is 20% to 25%, relative to reference products7
pending
  • Cost savings from converting to biosimilar pegfilgrastim could be as high as $1487 per patient (at a 35% discount) per chemotherapy cycle8
“An FDA-approved biosimilar is an appropriate substitute for filgrastim and pegfilgrastim ...”
—NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®)9
National Comprehensive Cancer Network® (NCCN®) makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.
Guideline Recommendations for Prophylaxis With a G-CSF

Primary prophylaxis with a G-CSF can reduce the incidence of febrile neutropenia3,10

  • Patients with cancer who received primary prophylaxis with a G-CSF were less likely to develop infection as manifested by febrile neutropenia10

Numerous biosimilar options present difficult choices for decision-makers

  • Navigating the needs of various decision-makers can make selecting the right G-CSF biosimilar for patients a complex process4,6
  • Selecting the right biosimilar depends on product quality, access and reimbursement, supply reliability, service support solutions, and manufacturing capabilities4,6,11
pending

With a complex biosimilar landscape, decision-makers require continued support to find more affordable treatment options6,7

G-CSF, granulocyte colony-stimulating factor.

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References:
  1. Crawford J, Dale DC, Lyman GH. Chemotherapy-induced neutropenia. Cancer. 2004;100(2):228-237. doi:10.1002/cncr.11882
  2. Tai E, Guy GP Jr, Dunbar A, Richardson LC. Cost of cancer-related neutropenia or fever hospitalizations, United States, 2012. J Oncol Pract. 2017;13(6):e552-e561. doi:10.1200/JOP.2016.019588
  3. Aapro M, Boccia R, Leonard R, et al. Refining the role of pegfilgrastim (a long-acting G-CSF) for prevention of chemotherapy-induced febrile neutropenia: consensus guidance recommendations. Support Care Cancer. 2017;25:3295-3304. doi: 10.1007/s00520-017-3842-1
  4. Cazap E, Jacobs I, McBride A, Popovian R, Sikora K. Global acceptance of biosimilars: importance of regulatory consistency, education, and trust. Oncologist. 2018;23(10):1188-1198. doi:10.1634/theoncologist.2017-0671
  5. Naeim A, Henk HJ, Becker L, et al. Pegfilgrastim prophylaxis is associated with a lower risk of hospitalization of cancer patients than filgrastim prophylaxis: a retrospective United States claims analysis of granulocyte colony-stimulating factors (G-CSF). BMC Cancer. 2013;13(1):11. doi:10.1186/1471-2407-13-11
  6. Tinsley SM, Grande C, Olson K, Plato L, Jacobs l. Potential of biosimilars to increase access to biologics: considerations for advanced practice providers in oncology. J Adv Pract Oncol. 2018;9(7):699-716. doi: 10.6004/jadpro.2018.9.7.2
  7. Patel KB, Arantes LH Jr, Tang WY, Fung S. The role of biosimilars in value-based oncology care. Cancer Manag Res. 2018;10:4591-4602. doi:10.2147/CMAR.S164201
  8. McBride A, Wang W, Campbell K, Balu S, MacDonald K, Abraham I. Economic modeling for the US of the cost-efficiency and associated expanded treatment access of conversion to biosimilar pegfilgrastim-bmez from reference pegfilgrastim. J Med Econ. 2020;23(8):856-863. doi:10.1080/13696998.2020.1760284
  9. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Hematopoietic Growth Factors V.1 2022. © National Comprehensive Cancer Network, Inc. 2021. All rights reserved. Accessed October 10, 2022. To view the most recent and complete version of the guideline, go online to NCCN.org.
  10. Herschman D, Hurley D, Wong M, Morrison VA, Malin JL. Impact of primary prophylaxis on febrile neutropenia within community practices in the US. J Med Econ. 2009;12(3):203-210. doi: 10.3111/13696990903238603
  11. Khraishi M, Stead D, Lukas M, Scotte F, Schmid H. Biosimilars: a multidisciplinary perspective. Clin Ther. 2016;38(5):1238-1249. doi:10.1016/j.clinthera.2016.02.023

Guideline recommendations for prophylaxis with a G-CSF

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) recommend prophylaxis with G-CSF when a chemotherapy regimen carries a high risk (>20%) of febrile neutropenia. The most recent updates of the American Society of Clinical Oncology (ASCO) and European Organization for Research and Treatment of Cancer (EORTC) guidelines have also adopted the 20% threshold for considering routine prophylactic myeloid growth factor support.1,2

For patients receiving a chemotherapy regimen that carries an intermediate risk (10%–20%) of developing febrile neutropenia, the NCCN Guidelines® recommend individualized consideration of prophylactic G-CSF use based on the presence of patient-specific risk factors. Patients with one or more risk factors should be considered for prophylactic G-CSF, while patients with no risk factors should be observed.1

National Comprehensive Cancer Network® (NCCN®) makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.

The American Society of Clinical Oncology recommends primary prophylaxis with G-CSF in patients with a ≥20% risk of febrile neutropenia, based on patient-, disease-, and treatment-related factors.3

Select chemotherapy agents in regimens associated with an intermediate risk (10%-20%) for febrile neutropenia2,4:

  • Paclitaxel
  • Cisplatin
  • Oxaliplatin
  • Docetaxel
  • Etoposide
  • Irinotecan
  • Gemcitabine
  • Fluorouracil
  
  • Doxorubicin
  • Leucovorin
  
References:
  1. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Hematopoietic Growth Factors V.1.2022. © National Comprehensive Cancer Network, Inc. 2021. All rights reserved. Accessed October 10, 2022. To view the most recent and complete version of the guideline, go online to NCCN.org.
  2. Referenced with permission from the National Comprehensive Cancer Network, Inc. © National Comprehensive Cancer Network, Inc. 2020. All rights reserved. Accessed February 25, 2021. To view the most recent and complete version of the recommendations, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.
  3. Smith TJ, Bohlke K, Lyman GH, et al; American Society of Clinical Oncology. Recommendations for the use of WBC growth factors: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol. 2015;33(28):3199-3212. doi:10.1200/JCO.2015.62.3488
  4. Weycker D, Li X, Edelsberg J, et al. Risk and consequences of chemotherapy-induced febrile neutropenia in patients with metastatic solid tumors. J Oncol Pract. 2015;11(1):47-54. doi:10.1200/JOP.2014.001492