Budget Impact Analysis of Treating Chemotherapy Patients with Patient-Administered Tbo-Filgrastim, Filgrastim-Sndz, and Filgrastim in the United States

Introduction: Neutropenia is a common complication in patients receiving myelosuppressive chemotherapy for nonmyeloid malignancies. Severe and febrile neutropenia are associated with prolonged hospitalization, serious infections and the use of broad-spectrum antibiotics, increased medical costs, and increased mortality. Granulocyte colony-stimulating factors (G-CSFs) are often administered to reduce the incidence, severity, and duration of febrile neutropenia in chemotherapy patients. The present analysis estimated the budget impact of increasing utilization of patient (home)-administered tbo-filgrastim and filgrastim-sndz in 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 costs associated with projected increases in the market share of tbo-filgrastim from 5% to 10% and filgrastim-sndz from 10% to 12% (with a corresponding decrease in filgrastim market share from 85% to 78%) for a 1 million-member health plan. Patient self-administration at home was assumed for 20% of patients receiving short-acting G-CSF treatment; all products were purchased through the patient's pharmacy benefit and were assumed to have Tier 3 formulary status with a patient co-pay of $54 per prescription. 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 $16,961 and $27,199, depending on dose and presentation, for tbo-filgrastim, between $16,216 and $26,015 for filgrastim-sndz, and between $19,134 and $30,663 for filgrastim. The estimated overall annual plan cost associated with short-acting G-CSFs was $53,298,217 (PMPY = $53.30) in the current scenario and $52,828,832 (PMPY = $52.82) in the future scenario. Estimated cost savings totaled $469,385 (PMPY = $0.48). The model was most sensitive to changes in the overall proportion of patients self-administering G-CSFs at home and to the wholesale acquisition cost for filgrastim.

Conclusions: The effective annual plan per-patient drug cost for tbo-filgrastim and filgrastim-sndz was lower by 11% and 15%, respectively, as compared with filgrastim. The present analysis estimated an annual US health plan cost savings approaching $0.5 million overall or $0.50 PMPY following an increase of market share by approximately 5% for tbo-filgrastim and 2% for filgrastim-sndz.