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Gascón P, Harbeck N, Rapoport BL, Anderson R, Brueckmann I, Howe S, Aapro M. Filgrastim biosimilar (EP2006): A review of 15 years' post-approval evidence. Crit Rev Oncol Hematol 2024; 196:104306. [PMID: 38401695 DOI: 10.1016/j.critrevonc.2024.104306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 02/26/2024] Open
Abstract
Filgrastim is approved for several indications, including reduction of the incidence and duration of chemotherapy-induced neutropenia and for stem cell mobilization. The filgrastim biosimilar, EP2006, has been available in Europe since 2009, and in the United States since 2015. In this time, preclinical and clinical data used to support the approval of EP2006 have been published. These data established the biosimilarity of EP2006 to reference filgrastim in terms of structure, pharmacokinetics, pharmacodynamics, efficacy, safety, and immunogenicity. Additional real-world evidence studies have also demonstrated equivalent efficacy and safety of EP2006 compared with reference filgrastim, both in the reduction of neutropenia and in stem cell mobilization in clinical practice. This review summarizes these preclinical, clinical, and real-world data, as well as the available cost-effectiveness data, for EP2006 since its approval 15 years ago.
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Affiliation(s)
- Pere Gascón
- Division of Medical Oncology, IDIBAPS, Hospital Clinic, Casanova 143, Barcelona 08036, Spain
| | - Nadia Harbeck
- Breast Center, Department OB&GYN and Center for hereditary Breast and Ovarian Cancer, LMU University Hospital, Marchioninistraße 15, Munich 81377, Germany
| | - Bernardo L Rapoport
- The Medical Oncology Centre of Rosebank, 129 Oxford Road, Johannesburg 2196, South Africa; Department of Immunology, Pathology Building, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa
| | - Ronald Anderson
- Department of Immunology, Pathology Building, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa
| | - Ines Brueckmann
- Sandoz Group AG, Global Medical Affairs, Industriestr. 25, Holzkirchen D-83607, Germany
| | - Sebastian Howe
- Sandoz Group AG, Global Medical Affairs, Industriestr. 25, Holzkirchen D-83607, Germany.
| | - Matti Aapro
- Cancer Center, Clinique de Genolier, Route du Muids 3, Genolier 1272, Switzerland
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Ismail S, Abu Esba L, Khan M, Al-Abdulkarim H, Modimagh H, Yousef C. An Institutional Guide for Formulary Decisions of Biosimilars. Hosp Pharm 2023; 58:38-48. [PMID: 36644755 PMCID: PMC9837324 DOI: 10.1177/00185787221138007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Biologics have changed the landscape for the management of many debilitating chronic diseases but account for a significant expenditure of medications globally. Fortunately, advances in technology paved the way for the introduction of biosimilars, which are highly similar to the originator biologics. In the quest to reduce the budget impact of biologics, organizations have begun to adopt biosimilars. Institutions evaluating biosimilars for inclusion in the hospital formulary must make informed formulary decisions by conducting a thorough review of key elements for evaluation of biosimilars and address the multidimensional aspects during the selection process of different biosimilar products. Therefore, we aim to present an institutional guide of these elements to inform formulary decisions. These key elements include biosimilar evaluation for formulary addition; regulatory approval; substitution, interchangeability, and switching; extrapolation; product characteristics, manufacturing, and supply chain issues; pharmacoeconomic evaluations; traceability, nomenclature, and coding; education; and pharmacovigilance.
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Affiliation(s)
- Sherin Ismail
- Pharmaceutical Care Department, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
- University of North Carolina, Chapel Hill, NC, USA
| | - Laila Abu Esba
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
- College of pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mansoor Khan
- Pharmaceutical Care Department, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
| | - Hana Al-Abdulkarim
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
- Doctoral School of Applied Informatics and Applied Mathematics, Óbuda University, Budapest, Hungary
- Drug Policy and Economic Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Hind Modimagh
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
- College of pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Consuela Yousef
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard Affairs, Dammam, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Al Ahsa, Saudi Arabia
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Yousef CC, Khan MA, Almodaimegh H, Alshamrani M, Al-Foheidi M, AlAbdalkarim H, AlJedai A, Naeem A, Abraham I. Cost-efficiency analysis of conversion to biosimilar filgrastim for supportive cancer care and resultant expanded access analysis to supportive care and early-stage HER2+ breast cancer treatment in Saudi Arabia: simulation study. J Med Econ 2023; 26:394-402. [PMID: 36815700 DOI: 10.1080/13696998.2023.2183680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
AIMS This study estimated, for Saudi Arabia, the cost-efficiency of converting patients from reference Neupogen and Neulastim to one of two filgrastim biosimilars (Nivestim, Zarzio); the budget-neutral expanded access to supportive care with biosimilar filgrastim and therapeutic care to ado-trastuzumab emtansine thus afforded; and the number-needed-to-convert (NNC) to provide supportive or therapeutic treatment to one patient. MATERIALS AND METHODS Replicating prior studies, we modeled the cost-efficiencies gained from converting varying proportions of a hypothetical panel of 4,000 patients undergoing six cycles of cancer treatment from Neupogen or Neulastim to one of the two biosimilar G-CSF formulations, using national cost inputs. Cost-savings in USD were used to estimate the additional doses of biosimilar G-CSF and expanded access to ado-trastuzumab emtansine on a budget-neutral basis, and NNC to purchase one additional dose of supportive or therapeutic treatment. RESULTS Savings from conversion from reference to a biosimilar filgrastim were $3,086,400 (Nivestim) and $3,460,800 (Zarzio). With reference pegfilgrastim, savings from conversion were $11,712,240 (Nivestim) and $12,086,640 (Zarzio). Biosimilar conversion from reference to biosimilar filgrastim enabled expanded access to ado-trastuzumab emtansine ranging from 61 patients (5 days, Nivestim) to 191 patients (14 days, Zarzio). For supportive care, biosimilar conversion enabled expanded access ranging from 8,244 patients (5 days, Nivestim) to 25,882 patients (14 days, Zarzio). For biosimilar conversion from daily filgrastim, the NNC for treatment with ado-trastuzumab emtansine decreased as days of injections increased [5 days: 395 (Nivestim), 352 (Zarzio); 14 days: 141(Nivestim), 126 (Zarzio)]. Alternately, for biosimilar conversion from single-injection pegfilgrastim to daily biosimilar filgrastim, the NNC for treatment with ado-trastuzumab emtansine rose as days of injections increased, being highest under the 14-day scenario (146, Nivestim; 130, Zarzio). CONCLUSION This simulation study demonstrated significant potential cost-savings from biosimilar conversion. These savings provide budget-neutral increased access to supportive and therapeutic cancer care.
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Affiliation(s)
- Consuela Cheriece Yousef
- Pharmaceutical Care Department, Ministry of National Guard - Health Affairs, Dammam, Saudi Arabia
- King Abdullah International Medical Research Center, Al Ahsa, Saudi Arabia
- King Saud bin Abdul-Aziz University for Health Sciences, Al Ahsa, Saudi Arabia
| | - Mansoor Ahmed Khan
- Pharmaceutical Care Department, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- King Saud bin Abdul-Aziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Hind Almodaimegh
- College of Pharmacy, King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Majed Alshamrani
- Pharmaceutical Care Department, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- King Saud bin Abdul-Aziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Meteb Al-Foheidi
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud bin Abdul-Aziz University for Health Sciences, Jeddah, Saudi Arabia
- Department of Oncology, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Hana AlAbdalkarim
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Drug Policy and Economic Center, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
- Doctoral School of Applied Informatics and Applied Mathematics, Obuda University, Budapest, Hungary
| | - Ahmed AlJedai
- Therapeutic Affairs, Ministry of Health, Riyadh, Saudi Arabia
- Colleges of Pharmacy and Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Anjum Naeem
- Pharmaceutical Care Department, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- King Saud bin Abdul-Aziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Ivo Abraham
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA
- Matrix45, Tucson, AZ, USA
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Gebremariam GT, Fentie AM, Beyene K, Sander B, Gebretekle GB. Cost-effectiveness of pegfilgrastim versus filgrastim for prevention of chemotherapy-induced febrile neutropenia in patients with lymphoma: a systematic review. BMC Health Serv Res 2022; 22:1600. [PMID: 36585648 PMCID: PMC9805270 DOI: 10.1186/s12913-022-08933-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 12/05/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Febrile neutropenia (FN) is a prevalent and potentially life-threatening complication in patients with lymphoma receiving myelosuppressive chemotherapy. Pegfilgrastim is more effective than filgrastim as prophylaxis for FN. However, its usage has been limited because of its higher cost. Pegfilgrastim's value for money remains unclear. OBJECTIVE To systematically review the cost-effectiveness of pegfilgrastim compared to filgrastim as a primary or secondary prophylaxis for chemotherapy-induced FN among patients with lymphoma. METHODS A systematic literature search was conducted in PubMed, EMBASE, Cochrane Library databases, and Google Scholar. The most widely used economic evaluations (cost-effectiveness analysis, cost-utility analysis and cost-benefit analysis) were included in the review. Data extraction was guided by the Consolidated Health Economic Evaluation Reporting Standards checklist, and the quality of reviewed articles was assessed using the Joanna Briggs Institute (JBI) checklist. Cost-effectiveness data were rigorously summarized and synthesized narratively. Costs were adjusted to US$ 2020. RESULTS We identified eight economic evaluation studies (two cost-utility analyses, three cost-effectiveness analyses, and three studies reporting both cost-effectiveness and cost-utility analyses). Half of these studies were from Europe (n = 4), the other half were from Iran, USA, Canada, and Singapore. Six studies met > 80% of the JBI quality assessment criteria. Cost-effectiveness estimates in the majority (n = 6) of these studies were for Non-Hodgkin Lymphoma patients receiving myelosuppressive chemotherapy with high-risk of FN (> 20%). The studies considered a wide range of baseline FN risk (17-97.4%) and mortality rates (5.8-8.9%). Reported incremental cost-effectiveness ratios ranged from US$ 2199 to US$ 8,871,600 per quality-adjusted life-year (QALY) gained, dominant to US$ 44,358 per FN averted, and US$ 4261- US$ 7251 per life-years gained. The most influential parameters were medication and hospitalization costs, the relative risk of FN, and assumptions of mortality benefit. CONCLUSIONS Most studies showed that pegfilgrastim is cost-effective compared to filgrastim as primary and secondary prophylaxis for chemotherapy-induced FN among patients with lymphoma at a cost-effectiveness threshold of US$ 50,000 per QALY gained. The findings could assist clinicians and healthcare decision-makers to make informed decisions regarding resource allocation for the management of chemotherapy-induced FN in settings similar to those studied.
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Affiliation(s)
- Girma Tekle Gebremariam
- grid.7123.70000 0001 1250 5688School of Pharmacy, Addis Ababa University, Zambia Street, P.O. box: 1176 Addis Ababa, Ethiopia
| | - Atalay Mulu Fentie
- grid.7123.70000 0001 1250 5688School of Pharmacy, Addis Ababa University, Zambia Street, P.O. box: 1176 Addis Ababa, Ethiopia
| | - Kebede Beyene
- grid.419579.70000 0000 8660 3507Department of Pharmaceutical and Administrative Sciences, University of Health Sciences and Pharmacy in St. Louis, St. Louis, USA
| | - Beate Sander
- grid.17063.330000 0001 2157 2938Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M6 Canada ,grid.231844.80000 0004 0474 0428Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, 200 Elizabeth Street, Toronto, Ontario M5G 2C4 Canada ,grid.418647.80000 0000 8849 1617Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, Ontario M4N 3M5 Canada ,grid.415400.40000 0001 1505 2354Public Health Ontario, 480 University Ave, Toronto, Ontario M5G 1V2 Canada
| | - Gebremedhin Beedemariam Gebretekle
- grid.17063.330000 0001 2157 2938Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M6 Canada ,grid.231844.80000 0004 0474 0428Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, 200 Elizabeth Street, Toronto, Ontario M5G 2C4 Canada ,grid.17063.330000 0001 2157 2938Centre for Vaccine-Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Real-World Use of Granulocyte-Colony Stimulating Factor in Patients with Breast Cancer from Alberta, Canada. Cancers (Basel) 2022; 14:cancers14246197. [PMID: 36551681 PMCID: PMC9777054 DOI: 10.3390/cancers14246197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/09/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND There are limited published data in the Canadian healthcare system on the use of granulocyte colony-stimulating factor (G-CSF) among patients with breast cancer. This study characterized real-world G-CSF use during the period surrounding the introduction of filgrastim biosimilar. METHODS Electronic medical records were reviewed retrospectively for patients with breast cancer who received moderately or highly myelosuppressive (neo)adjuvant chemotherapy from 2008 to 2019 in Alberta, Canada. Trends in G-CSF usage were plotted to elucidate temporal variations and multivariable regression models were constructed to identify clinical factors associated with G-CSF use. RESULTS We included 6662 patients in our analyses. G-CSF was used in 57.1% of patients during their treatment trajectory. Among the 3801 patients who were treated with G-CSF, the majority received pegfilgrastim only (91.5%; n = 3477) versus filgrastim only (5.7%; n = 217). G-CSF use increased linearly more than two-fold over the 11-year study period. Predictors of G-CSF use included younger age, south zone of residence, higher neighborhood education, inferior disease stage, highly neutropenic risk chemotherapy, and more recent chemotherapy initiation. CONCLUSIONS Despite increasing G-CSF usage over time, an appreciable proportion of patients for whom G-CSF prophylaxis is recommended did not receive it. G-CSF use could be further optimized to align with supportive care clinical guidelines and reduce the impact of neutropenia and its associated complications.
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Blayney DW, Schwartzberg L. Chemotherapy-Induced Neutropenia and Emerging Agents for Prevention and Treatment: A Review. Cancer Treat Rev 2022; 109:102427. [DOI: 10.1016/j.ctrv.2022.102427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/09/2022] [Accepted: 06/12/2022] [Indexed: 11/02/2022]
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Wong G, Wang K, Pasetka M, Zhang L, Lou J, Majeed H, Flores J, Lam E, DeAngelis C. The Real-World Experience of the Biosimilar (Grastofil®) to the Reference Biologic (Neupogen®) in Breast Cancer and Lymphoma: A Canadian Single-Centre Retrospective Study. Curr Oncol 2022; 29:1349-1369. [PMID: 35323315 PMCID: PMC8947031 DOI: 10.3390/curroncol29030115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/18/2022] [Accepted: 02/20/2022] [Indexed: 12/04/2022] Open
Abstract
Febrile neutropenia (FN) is a common side effect of cytotoxic chemotherapy that may result in poor treatment outcomes. The short acting granulocyte colony stimulating factors (G-CSF) act to stimulate granulocytes to increase production of white blood cells. The filgrastim biosimilar is useful, as it may provide a cheaper and equally effective treatment to FN. This study explored the usage of the filgrastim biosimilar (Grastofil®) and the reference biologic (Neupogen®) in breast cancer and lymphoma patients. A retrospective chart review of patients receiving Grastofil® from January 2017 to June 2019 or Neupogen® for primary prophylaxis of FN from January 2013 to December 2017 was conducted. The endpoints included the incidence of FN and the occurrence of dose reduction (DR) and dose delay (DD). One hundred and fifty-three Grastofil® patients were matched to 153 Neupogen® patients. This cohort was further split into breast cancer (n = 275) and non-Hodgkin’s lymphoma (n = 31) cohorts. After adjusting for chemotherapy cycles, the biosimilar filgrastim was non-inferior to the reference biologic based on FN incidence in addition to related outcomes including DR and DD.
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Affiliation(s)
- Gina Wong
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (K.W.); (M.P.); (H.M.); (E.L.); (C.D.)
- Correspondence:
| | - Katie Wang
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (K.W.); (M.P.); (H.M.); (E.L.); (C.D.)
| | - Mark Pasetka
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (K.W.); (M.P.); (H.M.); (E.L.); (C.D.)
| | - Liying Zhang
- Macrostat Inc., Toronto, ON L4B 4P4, Canada; (L.Z.); (J.L.)
| | - Julia Lou
- Macrostat Inc., Toronto, ON L4B 4P4, Canada; (L.Z.); (J.L.)
| | - Habeeb Majeed
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (K.W.); (M.P.); (H.M.); (E.L.); (C.D.)
| | - Jerome Flores
- Department of Pharmacy, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada;
| | - Emily Lam
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (K.W.); (M.P.); (H.M.); (E.L.); (C.D.)
| | - Carlo DeAngelis
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (K.W.); (M.P.); (H.M.); (E.L.); (C.D.)
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McBride A, Alrawashdh N, MacDonald K, Abraham I. Expanded access to anticancer treatments from conversion to biosimilar pegfilgrastim-cbqv in US breast cancer patients. Future Oncol 2021; 18:363-373. [PMID: 34747185 DOI: 10.2217/fon-2021-0979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aim: To estimate cost-savings from conversion to biosimilar pegfilgrastim-cbqv that could be reallocated to provide budget-neutral expanded access to AC (doxorubicin/cyclophosphamide) and TCH (docetaxel/carboplatin/trastuzumab) in breast cancer (BC) patients. Methods: Simulation modeling in panels of 20,000 BC and 5000 HER2-positive (HER2+ BC) patients, varying treatment duration (one-six cycles) and conversion rates (10-100%), to estimate cost-savings and additional AC and TCH treatment that could be provided. Results: In 20,000 patients, cost-savings of $1,083 per-patient per-cycle translate to $21,652,064 (one cycle) to $129,912,397 (six cycles). Savings range from $5,413,016 to $32,478,097, respectively, in the 5000-patient HER2+ BC panel. Conclusion: Conversion to pegfilgrastim-cbqv could save up to $130 million and provide more than 220,000 additional cycles of antineoplastic treatment on a budget-neutral basis to BC patients.
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Affiliation(s)
- Ali McBride
- Center for Health Outcomes & PharmacoEconomic Research, University of Arizona, Tucson, AZ USA.,University of Arizona Cancer Center, Tucson, AZ, USA.,Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Neda Alrawashdh
- Center for Health Outcomes & PharmacoEconomic Research, University of Arizona, Tucson, AZ USA
| | | | - Ivo Abraham
- Center for Health Outcomes & PharmacoEconomic Research, University of Arizona, Tucson, AZ USA.,University of Arizona Cancer Center, Tucson, AZ, USA.,Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA.,Matrix45, Tucson, AZ, USA
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Scotte F, Simon H, Laplaige P, Antoine EC, Spasojevic C, Texier N, Gouhier K, Chouaid C. Febrile neutropenia prophylaxis, G-CSF physician preferences: discrete-choice experiment. BMJ Support Palliat Care 2021:bmjspcare-2021-003082. [PMID: 34706865 DOI: 10.1136/bmjspcare-2021-003082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/08/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Febrile neutropenia (FN) commonly occurs during cancer chemotherapy. Prophylaxis with granulocyte colony-stimulating factors (G-CSFs) is known to reduce the severity and incidence of FN and infections in patients with cancer. Despite the proven efficacy, G-CSFs are not always prescribed as recommended. We performed a discrete-choice experiment (DCE) to determine what factors drive the physician preference for FN prophylaxis in patients with cancer undergoing chemotherapy. METHODS Attributes for the DCE were selected based on literature search and on expert focus group discussions and comprised pain at the injection site, presence of bone pain, associated fever/influenza syndrome, efficacy of prophylaxis, biosimilar availability, number of injections per chemotherapy cycle and cost. Oncologists, in a national database, were solicited to participate in an online DCE. The study collected the responses to the choice scenarios, the oncologist characteristics and their usual prescriptions of G-CSFs in the context of breast, lungs and gastrointestinal cancers. RESULTS Overall, the responses from 205 physicians were analysed. The physicians were mainly male (61%), with ≤20 years of experience (76%) and working only in public hospitals (73%). The physicians prescribe G-CSF primary prophylaxis for 32% of patients: filgrastim in 46% and pegfilgrastim in 54%. The choice of G-CSF for primary and secondary prophylaxis was driven by cost and number of injections. Biosimilars were well accepted. CONCLUSION Cost and convenience of G-CSF drive the physician decision to prescribe or not G-CSF for primary and secondary FN prophylaxes. It is important that these results be incorporated in the optimisation of G-CSF prescription in the clinical setting.
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Affiliation(s)
- Florian Scotte
- Interdisciplinary patient pathway department, Gustave Roussy Institute, Villejuif, France
| | | | | | | | | | | | | | - Christos Chouaid
- Service de Pneumologie, Centre Hospitalier Intercommunal de Creteil, Creteil, France
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Rastogi S, Kalaiselvan V, Ali S, Ahmad A, Guru SA, Sarwat M. Efficacy and Safety of Filgrastim and Its Biosimilars to Prevent Febrile Neutropenia in Cancer Patients: A Prospective Study and Meta-Analysis. BIOLOGY 2021; 10:biology10101069. [PMID: 34681169 PMCID: PMC8533340 DOI: 10.3390/biology10101069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/07/2021] [Accepted: 10/14/2021] [Indexed: 01/08/2023]
Abstract
Simple Summary Febrile neutropenia is the serious side-effect associated with myelosuppressive chemotherapy. Filgrastim, the first granulocyte colony-stimulating factor (G-CSF) was approved by the Food and Drug Administration for the treatment of neutropenia. Subsequently, pegfilgrastim (long-acting G-CSF) and filgrastim biosimilars were developed to have comparable efficacy to filgrastim. Therefore, it is necessary to produce a systematic review and meta-analysis that provides evidence that filgrastim is more efficacious than placebo/no-treatment, as it provides evidence on the comparable efficacy of filgrastim versus pegfilgrastim and biosimilar filgrastim. Abstract Background: The aim of this review and meta-analysis was to identify, assess, meta-analyze and summarize the comparative effectiveness and safety of filgrastim in head-to-head trials with placebo/no treatment, pegfilgrastim (and biosimilar filgrastim to update advances in the field. Methods: The preferred reporting items for systematic reviews and meta-analyses PRISMA statement were applied, and a random-effect model was used. Primary endpoints were the rate and duration of grade 3 or 4 neutropenia, and an incidence rate of febrile neutropenia. Secondary endpoints were time to absolute neutrophil count ANC recovery, depth of ANC nadir (lowest ANC), neutropenia-related hospitalization and other neutropenia-related complications. For filgrastim versus biosimilar filgrastim comparison, the primary efficacy endpoint was the mean difference in duration of severe neutropenia DSN. Results: A total of 56 studies were considered that included data from 13,058 cancer patients. The risk of febrile neutropenia in filgrastim versus placebo/no treatment was not statistically different. The risk ratio for febrile neutropenia was 0.58, a 42% reduction in favor of filgrastim. The most reported adverse event with FIL was bone pain. For pegfilgrastim versus filgrastim, no statistically significant difference was noted. The risk ratio was 0.90 (95% CI 0.67 to 1.12). The overall difference in duration of severe neutropenia between filgrastim and biosimilar filgrastim was not statistically significant. The risk ratio was 1.03 (95% CI 0.93 to 1.13). Conclusions: Filgrastim was effective and safe in reducing febrile neutropenia and related complications, compared to placebo/no treatment. No notable differences were found between pegfilgrastim and filgrastim in terms of efficacy and safety. However, a similar efficacy profile was observed with FIL and its biosimilars.
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Affiliation(s)
- Shruti Rastogi
- Indian Pharmacopoeia Commission, Ministry of Health & Family Welfare, Government of India, Sector-23, Raj Nagar, Ghaziabad 201002, Uttar Pradesh, India; (S.R.); (V.K.)
- Amity Institute of Pharmacy, Amity University, Noida 201301, Uttar Pradesh, India
| | - Vivekananda Kalaiselvan
- Indian Pharmacopoeia Commission, Ministry of Health & Family Welfare, Government of India, Sector-23, Raj Nagar, Ghaziabad 201002, Uttar Pradesh, India; (S.R.); (V.K.)
| | - Sher Ali
- School of Basic Sciences and Research, Department of Life Sciences, Sharda University, Greater Noida 201310, Uttar Pradesh, India;
| | - Ajaz Ahmad
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Sameer Ahmad Guru
- Lurie Children’s Hospital, Department of Pediatric Surgery, Northwestern University, Chicago, IL 60611, USA;
| | - Maryam Sarwat
- Amity Institute of Pharmacy, Amity University, Noida 201301, Uttar Pradesh, India
- Correspondence: or
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11
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MacDonald K, Alrawashdh N, McBride A, Abraham I. Conversion to biosimilar pegfilgrastim-cbqv enables budget-neutral access to FOLFIRINOX treatment for metastatic pancreatic cancer. Future Oncol 2021; 17:4561-4570. [PMID: 34382416 DOI: 10.2217/fon-2021-0718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To estimate the cost-savings from conversion to biosimilar pegfilgrastim-cbqv that can be reallocated to provide budget-neutral expanded access to FOLFIRINOX in patients with metastatic pancreatic cancer. Methods: Simulation modeling in a panel of 2500 FOLFIRINOX-treated patients, using varying treatment duration (1-12 cycles) and conversion rates (10-100%), to estimate cost-savings and additional FOLFIRINOX treatment that could be budget neutral. Results: In a 2500-patient panel at 100% conversion, savings of US$6,907.41 per converted patient over 12 cycles of prophylaxis translate to US$17.3 million and could provide 72,273 additional FOLFIRINOX doses or 6023 full 6-month regimens. Conclusion: Conversion to biosimilar CIN/FN prophylaxis can generate significant cost-savings and provide budget-neutral expanded access to FOLFIRINOX treatment for patients with metastatic pancreatic cancer.
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Affiliation(s)
| | - Neda Alrawashdh
- Center for Health Outcomes & PharmacoEconomic Research, University of Arizona, Tucson, AZ 85721, USA
| | - Ali McBride
- Center for Health Outcomes & PharmacoEconomic Research, University of Arizona, Tucson, AZ 85721, USA.,University of Arizona Cancer Center, Tucson, AZ 85724, USA.,Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA
| | - Ivo Abraham
- Matrix45, Tucson, AZ 85743, USA.,Center for Health Outcomes & PharmacoEconomic Research, University of Arizona, Tucson, AZ 85721, USA.,University of Arizona Cancer Center, Tucson, AZ 85724, USA.,Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA
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12
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Shayne M, Harvey RD, Lyman GH. Prophylaxis and treatment strategies for optimizing chemotherapy relative dose intensity. Expert Rev Anticancer Ther 2021; 21:1145-1159. [PMID: 34114525 DOI: 10.1080/14737140.2021.1941891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION A decrease in relative-dose intensity (RDI) of chemotherapy has been shown to be associated with poor patient outcomes in solid tumors and non-Hodgkin's lymphoma. The actual delivered chemotherapy dose received by patients can be influenced by dose reductions and treatment delays, often due to toxicities, most commonly chemotherapy-induced neutropenia (CIN). AREAS COVERED We review seminal evidence and more recent studies that have shown an association between higher RDI and improved patient survival. A smaller number of studies has shown no association between RDI and outcomes. These differences may be due to study limitations, including low power, differences in patient and disease characteristics, or the chemotherapeutic regimen. We describe guidelines recommendations to prevent and treat CIN with granulocyte-colony stimulating factor (G-CSF) and describe novel approaches to prevent neutropenia that are being developed that may provide greater value and be associated with fewer adverse events than standard G-CSF options. EXPERT OPINION Maintaining RDI is important to ensure optimal patient outcomes. This can be achieved through the proper administration of G-CSF prophylaxis and treatment. Newer agents in development to treat and/or prevent CIN are entering regulatory review and may potentially change the treatment landscape for CIN in the future.
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Affiliation(s)
| | - R Donald Harvey
- Winship Cancer Institute and Emory University School of Medicine, Department of Hematology and Medical Oncology, Atlanta, GA, USA
| | - Gary H Lyman
- Fred Hutchinson Cancer Research Center, The University of Washington, Seattle, WA, USA
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13
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Ditani AS, Mallick PP, Anup N, Tambe V, Polaka S, Sengupta P, Rajpoot K, Tekade RK. Biosimilars accessible in the market for the treatment of cancer. J Control Release 2021; 336:112-129. [PMID: 34126171 DOI: 10.1016/j.jconrel.2021.06.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 11/15/2022]
Abstract
Biosimilars are the biological product clinically identical to a biologic reference standard regarding their strength, purity, and safety. A large segment of biosimilars has been developed for the treatment of cancer. This review aims to discuss various facets of biosimilars and explicates on biosimilars accessible in the market for cancer clinical intervention. It also illustrates the outcomes of recent clinical trial studies concerning biosimilars. Further, it also crosstalk the safety profiles, regulatory approval requirements, and allied challenges therein. The work will be of significant interest to researchers working in the field of biologics and biosimilars.
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Affiliation(s)
- Aayushi S Ditani
- National Institute of Pharmaceutical Education and Research-Ahmedabad (NIPER-A), An Institute of National Importance, Government of India, Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, Palaj, Opp. Air force station, Gandhinagar 382355, Gujarat, India
| | - Pragyan Paramita Mallick
- National Institute of Pharmaceutical Education and Research-Ahmedabad (NIPER-A), An Institute of National Importance, Government of India, Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, Palaj, Opp. Air force station, Gandhinagar 382355, Gujarat, India
| | - Neelima Anup
- National Institute of Pharmaceutical Education and Research-Ahmedabad (NIPER-A), An Institute of National Importance, Government of India, Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, Palaj, Opp. Air force station, Gandhinagar 382355, Gujarat, India
| | - Vishakha Tambe
- National Institute of Pharmaceutical Education and Research-Ahmedabad (NIPER-A), An Institute of National Importance, Government of India, Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, Palaj, Opp. Air force station, Gandhinagar 382355, Gujarat, India
| | - Suryanarayana Polaka
- National Institute of Pharmaceutical Education and Research-Ahmedabad (NIPER-A), An Institute of National Importance, Government of India, Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, Palaj, Opp. Air force station, Gandhinagar 382355, Gujarat, India
| | - Pinaki Sengupta
- National Institute of Pharmaceutical Education and Research-Ahmedabad (NIPER-A), An Institute of National Importance, Government of India, Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, Palaj, Opp. Air force station, Gandhinagar 382355, Gujarat, India
| | - Kuldeep Rajpoot
- National Institute of Pharmaceutical Education and Research-Ahmedabad (NIPER-A), An Institute of National Importance, Government of India, Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, Palaj, Opp. Air force station, Gandhinagar 382355, Gujarat, India
| | - Rakesh K Tekade
- National Institute of Pharmaceutical Education and Research-Ahmedabad (NIPER-A), An Institute of National Importance, Government of India, Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, Palaj, Opp. Air force station, Gandhinagar 382355, Gujarat, India.
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14
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Wang W, Li E, Campbell K, McBride A, D'Amato S. Economic Analysis on Adoption of Biosimilar Granulocyte Colony-Stimulating Factors in Patients With Nonmyeloid Cancer at Risk of Febrile Neutropenia Within the Oncology Care Model Framework. JCO Oncol Pract 2021; 17:e1139-e1149. [PMID: 33961490 PMCID: PMC8360455 DOI: 10.1200/op.20.00994] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Value-based programs, such as the Oncology Care Model (OCM), seek to improve care for patients undergoing chemotherapy, while reducing total costs. The purpose of this study is to quantify the impact of adopting biosimilar granulocyte colony-stimulating factors (G-CSFs) for febrile neutropenia (FN) primary prophylaxis (PP) from a US practice perspective.
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Affiliation(s)
| | | | | | - Ali McBride
- University of Arizona Cancer Center, University of Arizona College of Pharmacy, Tucson, AZ
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15
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McBride A, MacDonald K, Abraham I. Conversion to supportive care with biosimilar pegfilgrastim-cbqv enables budget-neutral expanded access to R-CHOP treatment in non-Hodgkin lymphoma. Leuk Res 2021; 106:106591. [PMID: 33957339 DOI: 10.1016/j.leukres.2021.106591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Abstract
This pharmacoeconomic simulation (1) assessed the cost-efficiency of converting a panel of 20,000 patients at risk of chemotherapy-induced (febrile) neutropenia (CIN/FN) from reference pegfilgrastim to biosimilar pegfilgrastim-cbqv; (2) estimated how savings can be used to provide budget-neutral expanded access to R-CHOP therapy for non-Hodgkin lymphoma patients; and 3) determined the number-needed-to-convert (NNC) to purchase one additional dose of R-CHOP (US payer perspective). Model inputs included biosimilar conversion from pre-filled syringe [PFS] or on-body injector [OBI] reference pegfilgrastim; age-proportional blended costs for reference pegfilgrastim PFS and OBI, pegfilgrastim-cbqv and R-CHOP; medication administration costs; biosimilar conversion rates of 10-100 %; and 1-6 cycles of prophylaxis. Cost-savings were used to estimate the number of doses of R-CHOP that could be purchased and the NNC to purchase one additional dose. Converting a panel of 20,000 patients requiring CIN/FN prophylaxis to biosimilar pegfilgrastim-cbqv from a low of 1 cycle and 10 % conversion to a high of 6 cycles and 100 % conversion yielded savings from $1,567,195 to $96,668,126. The budget-neutral acquisition of R-CHOP doses afforded by these savings ranged from 227 to 13,999 doses, the latter enabling 2333 patients to receive 6 cycles of R-CHOP treatment with no additional cost to the payer. These results are achieved if all 20,000 panel patients requiring GCSF support are prophylacted with biosimilar pegfilgrastim-cbqv for 6 cycles, yielding an NNC of 1.43 patients per additional R-CHOP dose. This simulation underscores the clinic-economic benefit of prophylaxis with biosimilar growth factor and pegfilgrastim-cbqv specifically.
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Affiliation(s)
- Ali McBride
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA; University of Arizona Cancer Center, Tucson, AZ, USA; Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | | | - Ivo Abraham
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA; University of Arizona Cancer Center, Tucson, AZ, USA; Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA; Matrix45, Tucson, AZ, USA.
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16
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Dutta B, Huys I, Vulto AG, Simoens S. Identifying Key Benefits in European Off-Patent Biologics and Biosimilar Markets: It is Not Only About Price! BioDrugs 2021; 34:159-170. [PMID: 31792843 PMCID: PMC7113204 DOI: 10.1007/s40259-019-00395-w] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Biosimilar medicines have shown similarity with the originator biologic and offer a similar clinical outcome generally at a lower cost. This paper identifies benefits of off-patent biologics and biosimilars, and illustrates these benefits with empirical data from Europe. We provide a narrative review of published literature on values and benefits of biosimilars in Europe. The results describe cost savings as the key driver stemming from the lower price of biosimilars, than that of originator products, and from price competition between biosimilar(s), originator, and next-generation products. Cost savings may then translate into a number of other associated benefits. The lower price of biosimilars and similar effectiveness to the originator biologics improve cost effectiveness, implying that reimbursement can be granted or extended to other patient groups, or that the biologic therapy can be moved to an earlier line of treatment. Cost savings from biosimilars can be used to increase patient access to therapy or to increase the number of healthcare professionals. Finally, competition between off-patent biologics and biosimilars may stimulate an innovation in the formulation and development of next-generation biologics. Our paper illustrates that the benefit of off-patent biologics and biosimilars is not restricted to cost savings, but that these medicines may contribute to an expansion of medical treatment options for patients, hence concomitantly contributing to the long-term sustainability of the healthcare system. This review provides a broader view for clinical and economic decision makers and healthcare professionals on the added benefits of off-patent biologics and their use in clinical practice.
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Affiliation(s)
- Binita Dutta
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Louvain, Belgium
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Louvain, Belgium
| | - Arnold G Vulto
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Louvain, Belgium. .,Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Louvain, Belgium
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17
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Cornes P, Gascon P, Vulto AG, Aapro M. Biosimilar Pegfilgrastim: Improving Access and Optimising Practice to Supportive Care that Enables Cure. BioDrugs 2021; 34:255-263. [PMID: 32232676 PMCID: PMC7211191 DOI: 10.1007/s40259-020-00411-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Febrile neutropenia (FN) is a serious complication of chemotherapy, which can cause significant morbidity and mortality, result in dose delays and reductions and, ultimately, reduce cancer survival. Over the past decade, the availability of biosimilar filgrastim (short-acting granulocyte colony-stimulating factor [G-CSF]) has transformed patient access, with clear evidence of clinical benefit at preventing FN at reduced costs. In 2019, seven biosimilar pegfilgrastims (long-acting G-CSFs) were licensed, creating optimal market conditions and choice for prescribers. FN affects up to 117 per 1000 cancer patients, with mortality rates in the range of 2–21%. By reducing FN incidence and improving chemotherapy relative dose intensity (RDI), G-CSF has been associated with a 3.2% absolute survival benefit. Guidelines recommend primary prophylaxis and that filgrastim be administered for 10–14 days, while pegfilgrastim is administered once per cycle. When taken according to the guidelines, pegfilgrastim and filgrastim are equally effective. However, in routine clinical practice, filgrastim is often under-dosed (< 7 days) and has been shown to be inferior to pegfilgrastim at reducing FN incidence, hospitalisations and maintaining RDI. Once-per-cycle administration with pegfilgrastim might also aid patient adherence. The introduction of biosimilar pegfilgrastim should instigate a rethink of neutropenia management. Biosimilar pegfilgrastim offers countries using biosimilar filgrastim opportunities to improve adherence and thus cancer survival, whilst offering economic benefits for countries using reference pegfilgrastim. These benefits can be realised in full if biosimilar pegfilgrastim becomes part of routine clinical practice supported by drug and therapeutic committees implementing guidelines with multidisciplinary support in the hospital.
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Affiliation(s)
| | - Pere Gascon
- Department of Hematology-Oncology, University of Barcelona, Barcelona, Spain
| | - Arnold G Vulto
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Matti Aapro
- Cancer Center, Clinique de Genolier, Vaud, Switzerland
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18
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McBride A, MacDonald K, Fuentes-Alburo A, Abraham I. Conversion from pegfilgrastim with on-body injector to pegfilgrastim-jmdb: cost-efficiency analysis and budget-neutral expanded access to prophylaxis and treatment. J Med Econ 2021; 24:598-606. [PMID: 33866947 DOI: 10.1080/13696998.2021.1916863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIMS Therapeutic guidelines recommend prophylaxis against chemotherapy-induced (febrile) neutropenia (CIN/FN). Pegfilgrastim (Neulasta), biosimilar pegfilgrastim-jmdb (Fulphila), and pegfilgrastim with on-body injector (OBI; Neulasta Onpro) are options for CIN/FN prophylaxis. We aimed to simulate the cost-savings and budget-neutral expanded access to CIN/FN prophylaxis or anticancer treatment achieved through conversion from pegfilgrastim-OBI to pegfilgrastim-jmdb and to evaluate the economic impact of FN-related hospitalization costs due to pegfilgrastim-OBI failure. METHODS Cost-savings from conversion from pegfilgrastim-OBI to biosimilar pegfilgrastim-jmdb were simulated in a panel of 15,000 patients with cancer from the US payer perspective. The primary analyses included conversion rates of 10% to 100%. Adjusted analyses also considered OBI device failure rates of 1% to 7% and associated costs of FN-related hospitalization. Simulations of budget-neutral expanded access to prophylaxis with pegfilgrastim-jmdb or to rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) for diffuse large B-cell lymphoma (DLBCL) were also performed. RESULTS In a 15,000-patient panel, conversion from pegfilgrastim-OBI to pegfilgrastim-jmdb resulted in cost-savings ranging from $481,259 (10% conversion) to $4,812,585 (100% conversion) in a single cycle. Over 6 cycles at 100% conversion, savings were $28,857,510 and could provide 9,191 additional doses of pegfilgrastim-jmdb or 4,463 cycles of R-CHOP to patients with DLBCL. Adjusted for OBI failure, cost-savings over 6 cycles ranged from $2,935,565 (10% conversion; pegfilgrastim-OBI failure rate of 1%) to $32,236,499 (100% conversion; 7% failure). These cost-savings could provide 943 doses of pegfilgrastim-jmdb or 454 doses of R-CHOP (10% conversion; 1% pegfilgrastim-OBI failure) or provide 10,261 doses of pegfilgrastim-jmdb or 4,982 cycles of R-CHOP (100% conversion; 7% failure). CONCLUSION Conversion from pegfilgrastim to pegfilgrastim-jmdb is associated with significant cost-savings which increase markedly when also accounting for pegfilgrastim-OBI failure and associated FN-related hospitalizations. These general and failure-related cost-savings could be allocated on a budget-neutral basis to provide more patients with additional CIN/FN prophylaxis or antineoplastic treatment.
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Affiliation(s)
- Ali McBride
- The University of Arizona Cancer Center, Tucson, AZ, USA
- Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy, Tucson, AZ, USA
- Banner University Medical Center, Tucson, AZ, USA
| | | | | | - Ivo Abraham
- The University of Arizona Cancer Center, Tucson, AZ, USA
- Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy, Tucson, AZ, USA
- Matrix45, Tucson, AZ, USA
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA
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19
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McBride A, MacDonald K, Fuentes-Alburo A, Abraham I. Cost-efficiency and expanded access modeling of conversion to biosimilar trastuzumab-dkst with or without pertuzumab in metastatic breast cancer. J Med Econ 2021; 24:743-756. [PMID: 34003067 DOI: 10.1080/13696998.2021.1928515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIMS To investigate the cost-efficiency and budget-neutral expanded access of biosimilar intravenous trastuzumab-dkst versus reference intravenous (trastuzumab-IV) and subcutaneous trastuzumab (trastuzumab-SC) (with/without pertuzumab) in metastatic breast cancer (MBC). METHODS Economic simulation modeling in a panel of 1,000 MBC patients to estimate: 1) cost-savings by conversion from trastuzumab-IV or trastuzumab-SC to trastuzumab-dkst at 10-100% conversion rates in 3 weight groups: first quartile (Q1:62.2 kg), median (73.1 kg), third quartile (Q3:88.6 kg), and 2) budget-neutral expanded access to trastuzumab-dkst from cost-savings. RESULTS In monotherapy, conversion (%) from trastuzumab-IV generates one-year cost-savings from $2,272,189 (Q1;10%) to $31,506,804 (Q3;100%) and from trastuzumab-SC monotherapy savings range from $2,071,277 (Q3;10%) to $35,775,475 (Q1;100%). In combination with pertuzumab, trastuzumab-dkst is cost-efficient in all patient weights with one-year savings over trastuzumab-IV up to $32,662,714 (Q3;100%) and over trastuzumab-SC up to $35,322,461 (Q1;100%). Savings from conversion from trastuzumab-IV monotherapy could provide between 3,087 (Q1;10%) and 30,911 (Q3;100%) additional trastuzumab-dkst doses-enough to treat 58 to 583 patients for one year. Conversion from trastuzumab-SC monotherapy could provide between 1,559 (Q3;10%) and 48,598 (Q1;100%) additional trastuzumab-dkst doses or 38 to 918 additional one-year treatments with trastuzumab-dkst. In combination with pertuzumab, conversion from trastuzumab-IV could provide from 311 (Q1;10%) to 3,939 (Q3;100%) maintenance doses (pertuzumab + trastuzumab-dkst) or 17 to 210 additional one-year regimens (all agents). Savings from conversion from trastuzumab-SC could expand access to 226 (Q3;10%) to 4,782 (Q1;100%) additional maintenance doses or 12 to 254 one-year regimens. CONCLUSIONS This first cost-efficiency and expanded access study of biosimilar therapeutic cancer agents shows that trastuzumab-dkst is cost-efficient over trastuzumab-IV and trastuzumab-SC across all patient weights in both monotherapy and combination with pertuzumab and paclitaxel. These cost savings could provide more patients with trastuzumab-dkst treatment on a budget-neutral basis.
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Affiliation(s)
- Ali McBride
- The University of Arizona Cancer Center, Tucson, AZ, USA
- Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy, Tucson, AZ, USA
- Banner University Medical Center, Tucson, AZ, USA
| | | | | | - Ivo Abraham
- The University of Arizona Cancer Center, Tucson, AZ, USA
- Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy, Tucson, AZ, USA
- Matrix45, Tucson, AZ, USA
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA
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MacDonald K, McBride A, Alrawashdh N, Abraham I. Cost-efficiency and expanded access of prophylaxis for chemotherapy-induced (febrile) neutropenia: economic simulation analysis for the US of conversion from reference pegfilgrastim to biosimilar pegfilgrastim-cbqv. J Med Econ 2020; 23:1466-1476. [PMID: 33023360 DOI: 10.1080/13696998.2020.1833339] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
AIMS In this pharmacoeconomic simulation, we: (1) modeled the cost-efficiency of converting patients from reference pegfilgrastim to biosimilar pegfilgrastim-cbqv for prophylaxis of chemotherapy-induced (febrile) neutropenia (CIN/FN) from the US payer perspective, (2) simulated how savings enable, on a budget-neutral basis, expanded access to pegfilgrastim-cbqv, and (3) estimated the number-needed-to-convert (NNC) to purchase one additional dose of pegfilgrastim-cbqv. METHODS In a hypothetical panel of 20,000 patients, we modeled cost-savings utilizing: two reference formulations (pre-filled syringe [PFS] and on-body injector [OBI]), three medication cost inputs (average sales price [ASP], wholesale acquisition cost [WAC], and an age-proportionate blended ASP/WAC rate), administration cost for injection (PFS) and device application (OBI), conversion rates of 10-100%, and 1-6 cycles of prophylaxis. Cost-savings were used to estimate additional doses of pegfilgrastim-cbqv that could be purchased and the NNC to purchase one additional dose. RESULTS Using ASP and 10% conversion from reference OBI to pegfilgrastim-cbqv, savings range from $326,744 (1 cycle) to $2.0M (6 cycles) which could provide 93-556 additional doses of pegfilgrastim-cbqv, respectively; the NNC to purchase one additional dose of pegfilgrastim-cbqv ranges from 21.6 (1 cycle) down to 3.6 patients (6 cycles). The WAC model saves $41.1M per cycle and $246.7M over 6 cycles at 100% conversion from reference PFS which could provide 9,709-58,253 additional pegfilgrastim-cbqv doses; the NNC ranges from 2.1 (1 cycle) to 0.3 (6 cycles). Using the blended ASP/WAC rate, converting 50% from reference OBI to pegfilgrastim-cbqv would save $10.2M per cycle and $60.9M over 6 cycles providing 2,638-15,829 additional doses of pegfilgrastim-cbqv; NNCs are 3.8 (1 cycle) and 0.6 patients (6 cycles). CONCLUSIONS Converting 20,000 patients from reference to pegfilgrastim-cbqv over 6 cycles can generate savings up to $246.7M, enough to purchase up to 58,253 additional doses of pegfilgrastim-cbqv. This simulation provides economic justification for prophylaxis with biosimilar pegfilgrastim-cbqv.
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Affiliation(s)
| | - Ali McBride
- Medical Center, Banner University, Tucson, AZ, USA
- Cancer Center, University of Arizona, Tucson, AZ, USA
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Neda Alrawashdh
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA
| | - Ivo Abraham
- Matrix45, Tucson, AZ, USA
- Cancer Center, University of Arizona, Tucson, AZ, USA
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA
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Huang HY, Liu CC, Yu Y, Wang L, Wu DW, Guo LW, Wang SH, Fang H, Bai Y, Fang Y, Fan Q, Sun C, Wu Y, Shi JF, Ma F, Tang Y, Dai M, Li N. Pharmacoeconomic Evaluation of Cancer Biosimilars Worldwide: A Systematic Review. Front Pharmacol 2020; 11:572569. [PMID: 33536905 PMCID: PMC7849203 DOI: 10.3389/fphar.2020.572569] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 10/06/2020] [Indexed: 12/21/2022] Open
Abstract
Background and Purpose: The availability of oncology biosimilars is deemed as a fundamental strategy to achieve sustainable health care. However, there is scarce systematic evidence on economic effectiveness of cancer biosimilars. We aimed to synthesize evidence from pharmacoeconomic evaluation of oncology biosimilars globally, provide essential data and methodological reference for involved stakeholders. Materials and Methods: This systematic review was conducted in PubMed, embase, the Cochrane library, CRD, ISPOR and NICE utill December 31, 2019. Information on basic characteristics, evaluation methodology and results were extracted. Quality of included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards Checklist. Results: For 17 studies identified (13 from Europe and four from United States), the overall quality was generally acceptable. A total of seven biological molecules involved with filgrastim, EPOETIN α, and trastuzumab leading the three. The mostly common evaluation perspective was payer, but the time horizon varied greatly. There were ten studies which adopted cost minimization analysis to evaluate efficiency while seven studies adopted budget impact analysis to address affordability, with cost ratio and cost saving being its corresponding primary endpoint. Although the comparability of included studies was limited and specific results were largely affected by uptake and price discount rates of the oncology biosimilar, the comprehensive results consistently favored its promotion. Conclusion: Globally, the economic evaluation of cancer biosimilars is in its initial phase. However, limited evidence from developed countries consistently supported both cost-effectiveness of efficiency and affordability of oncology biosimilars, while they were largely affected by uptake and price discount rate.
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Affiliation(s)
- Hui-Yao Huang
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Cheng-Cheng Liu
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue Yu
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Le Wang
- Institute of Cancer and Basic Medicine, Cancer Hospital of the University of Chinese Academy of Sciences, Hangzhou, China
| | - Da-Wei Wu
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lan-Wei Guo
- Office for Cancer Control and Research, Henan Cancer Hospital, Zhengzhou University, Zhengzhou, China
| | - Shu-Hang Wang
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong Fang
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Bai
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Fang
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Fan
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chao Sun
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Wu
- Pfizer Investment Co., Ltd., Shanghai, China
| | - Ju-Fang Shi
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Ma
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Tang
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Dai
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Li
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Tilleul PR, Rodgers-Gray BS, Edwards JO. Introduction of biosimilar pegfilgrastim in France: Economic analysis of switching from originator. J Oncol Pharm Pract 2020; 27:1604-1615. [DOI: 10.1177/1078155220962208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives To assess the economic impact of introducing biosimilar pegfilgrastim compared to the current standard granulocyte colony-stimulating factor (G-CSF) practice in France. Methods A budget impact model was developed to investigate the impact of introducing pegfilgrastim biosimilar over 5 years. The model analysed drug acquisition costs, ambulatory costs, as well as costs associated with poor outcomes, and compared the current standard practice of long-acting and short-acting G-CSF to a revised practice including pegfilgrastim biosimilar in addition to standard practice treatments. The cost of switching to pegfilgrastim biosimilar, within a pharmacy setting, was analysed within the model using data from a survey of French pharmacists. Results The budget impact model calculated a cost saving of €51,007,531 over 5 years switching from the current standard practice to pegfilgrastim biosimilar. A sensitivity analysis accounting for variation in pegfilgrastim biosimilar uptake of 1) 15% in year 1 and 1% in years 2–5 and 2) 15% in years 1–5, estimated savings ranging between €29,377,784 and €79,847,194, respectively. A further analysis predicted cost savings of €287,344,835 over 5 years with the extension of pegfilgrastim biosimilar, at an uptake of 15% in year 1 and 7% in years 2–4, to both long-acting and short-acting G-CSF groups compared to unchanged current practice. Conclusions The introduction of pegfilgrastim biosimilar will help to reduce cost and alleviate some of the financial pressure on the French healthcare system.
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Affiliation(s)
- Patrick R Tilleul
- AP-HP, Sorbonne Université- Pitié Salpêtrière, Paris, France
- Faculte de pharmacie – Université Paris Descartes, Paris, France
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Hübel K, Kron F, Lux MP. Biosimilars in oncology: Effects on economy and therapeutic innovations. Eur J Cancer 2020; 139:10-19. [PMID: 32950935 DOI: 10.1016/j.ejca.2020.07.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/15/2020] [Indexed: 02/08/2023]
Abstract
AIM The introduction of new and innovative treatment options for cancer patients is accompanied by a tremendous increase in healthcare costs. Consequently, new financing approaches are strongly needed to reduce the burden on the healthcare system. The introduction of biosimilars - biological drugs containing the active substance of an already approved reference biological drug - can potentially relieve the burden on healthcare systems. Calculating the costs for three frequently used biosimilars, we simulated the health-economic impact of biosimilars in the real world for the German healthcare system. METHODS Based on available health-economic analyses, the actual prescription and cost containment potential of biosimilars compared to the originator were calculated exemplarily for the cost-intensive therapies trastuzumab in breast cancer, rituximab in follicular lymphoma and G-CSF in supportive care. Incidence calculations were based e.g. on data from the Robert-Koch-Institution, Munich Cancer Registry, and quality indicators of certified centres. Cost calculation was based on Lauer-Taxe® (official reference for pharmaceutical price information). RESULTS The application of biosimilars would generate potential annual savings for the chosen examples of up to 4.9 Mio EUR for rituximab in follicular lymphoma, 40.5 Mio EUR for filgrastim, 56.4 Mio EUR for pegfilgrastim, and between 95.9 and 120.5 Mio EUR for trastuzumab. CONCLUSIONS The consequent use of biosimilars allows a considerable reduction of overall treatment costs, especially for cost-intensive long-term maintenance treatments and therapies with high incidences. If the option of biosimilar usage is fully exploited, enormous resources could be released within the healthcare system in order to offset financing new innovative therapies.
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Affiliation(s)
- Kai Hübel
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Dept. I of Internal Medicine, Kerpener Str. 62, 50937, Köln, Germany.
| | - Florian Kron
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Dept. I of Internal Medicine, Kerpener Str. 62, 50937, Köln, Germany; FOM University of Applied Sciences, Herkulesstraße 32; 45127, Essen, Germany.
| | - Michael Patrick Lux
- Kooperatives Brustzentrum Paderborn, Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn, Frauenklinik St. Josefs, Salzkotten, Frauen- und Kinderklinik St. Louise, Husener Str. 81, 33098, Paderborn, Germany.
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24
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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; 23:856-863. [PMID: 32323582 DOI: 10.1080/13696998.2020.1760284] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aims: For this economic analysis, we aimed to model: (1) the cost-efficiency of prophylaxis with biosimilar pegfilgrastim-bmez for chemotherapy-induced (febrile) neutropenia (CIN/FN) compared to reference pegfilgrastim, and (2) the expanded access to CIN/FN prophylaxis and anti-neoplastic treatment that could be achieved with biosimilar cost-savings on a budget-neutral basis.Methods: In a hypothetical panel of 20,000 cancer patients receiving CIN/FN prophylaxis and using the average sales price (ASP) for the second quarter of 2019 for reference pegfilgrastim, we: conducted an ex ante simulation from the payer perspective of the cost-savings of 10-100% conversion from reference to biosimilar pegfilgrastim-bmez using drug price discounting ranging from 10-35%; estimated the budget-neutral expanded access to biosimilar pegfilgrastim-bmez enabled by these cost-savings; and estimated the budget-neutral expanded access to anti-neoplastic treatment with pembrolizumab. The simulations were replicated using fourth quarter 2019 wholesale acquisition cost (WAC) for reference pegfilgrastim and biosimilar pegfilgrastim-bmez in a post facto analysis.Results: In ASP simulations, cost-savings of using pegfilgrastim-bmez over reference pegfilgrastim in a 20,000 patient panel range from $1.3 M (at 15% price discount) to $3 M (35%) at 10% conversion rate and from $6.4 M to $14.9 M, respectively, at 50% conversion. These savings could provide prophylaxis with pegfilgrastim-bmez to an additional 352 (15% discount) to 1,076 patients (35%) at 10% conversion or 1,764-5,384, respectively, at 50% conversion. Alternatively, savings could be reallocated for anti-neoplastic treatment with pembrolizumab to 3 (15% discount) to 9 (35%) patients at 10% conversion or 19-45, respectively, at 50% conversion. When utilizing WAC, cost-savings range from $4.6 M (10% conversion) to $23.1 M (50%) which could provide pegfilgrastim-bmez to an additional 1,174 (10% conversion) to 5,873 patients (50%).Conclusions: Prophylaxis with biosimilar pegfilgrastim-bmez increases the value of cancer care by generating significant cost-savings that could be reallocated to provide expanded access to CIN/FN prevention and anti-neoplastic therapy on a budget-neutral basis.
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Affiliation(s)
- Ali McBride
- Arizona Cancer Center, Banner University Medical Center, Tucson, AZ, USA
- College of Pharmacy, University of Arizona Health Sciences Center, Tucson, AZ, USA
- Department of Pharmacy Practice and Science College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Weijia Wang
- Department of Health Economics and Outcome Research, Sandoz Inc, Princeton, NJ, USA
| | - Kim Campbell
- Department of Health Economics and Outcome Research, Sandoz Inc, Princeton, NJ, USA
| | - Sanjeev Balu
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Ivo Abraham
- College of Pharmacy, University of Arizona Health Sciences Center, Tucson, AZ, USA
- Department of Pharmacy Practice and Science College of Pharmacy, University of Arizona, Tucson, AZ, USA
- MATRIX45, Tucson, AZ, USA
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA
- Department of Family and Community Medicine College of Medicine - Tucson, University of Arizona, Tucson, AZ, USA
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25
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Parody R, Sánchez-Ortega I, Ferrá C, Guardia R, Talarn C, Encuentra M, Fort E, López D, Morgades M, Alonso E, Ortega S, Sarrá J, Gallardo D, Ribera JM, Sureda A. Mobilization of Hematopoietic Stem Cells into Peripheral Blood for Autologous Transplantation Seems Less Efficacious in Poor Mobilizers with the Use of a Biosimilar of Filgrastim and Plerixafor: A Retrospective Comparative Analysis. Oncol Ther 2020; 8:311-324. [PMID: 32700041 PMCID: PMC7683658 DOI: 10.1007/s40487-020-00115-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction Biosimilars of granulocyte colony-stimulating factors (G-CSF) have shown similar efficacy to originator filgrastim (Neupogen® [NEU]; Amgen Inc.) as prophylaxis in neutropenia and in the mobilization of stem cells in patients receiving combination chemotherapy with G-CSF. Methods This was a retrospective study in which the characteristics of stem cell mobilization treated with a G-CSF alone were compared in 216 patients and 56 donors. The two G-CSF compared were NEU and the biosimilar filgrastim Zarzio® (Sandoz GmbH) (referred to hereafter as BIO). Primary objectives were mobilization rate (minimum of 10 × 103/ml CD34+ on day 4 of treatment [day +4]) and use of the immunostimulant plerixafor (PLEX) in each group. Results The general characteristics of the patients receiving NEU (n = 138) and those receiving BIO (n = 78) did not differ significantly. PLEX was used in 24% of BIO patients and in 25.7% of NEU patients. The median CD34+ cell count on day +4 was significantly lower in BIO patients who needed PLEX than in those who did not (2.4 vs. 4.8 × 103/ml; p = 0.002), as was the final CD34+ cell count (2.5 vs. 3.3 × 106/kg; p 0.03). Mobilization failure rate was higher in the BIO group than in the NEU group (20 vs. 0%; p = 0.01). With respect to donors, more than one apheresis was needed in three BIO donors, one of them with PLEX. The use of BIO was the only risk factor for mobilization failure in patients who needed PLEX (hazard ratio 10.3; 95% confidence interval 1.3–77.8). Conclusion The study revealed that BIO had a lower efficacy for stem cell mobilization when the only treatment was G-CSF, especially in poor mobilizers needing PLEX.
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Affiliation(s)
- Rocío Parody
- Clinical Hematology Department, Institut Català d'Oncologia, L'Hospitalet, Institut d'Investigacio Biomedica de Bellvitge (IDIBELL), Barcelona, Spain.
| | - Isabel Sánchez-Ortega
- Clinical Hematology Department, Institut Català d'Oncologia, L'Hospitalet, Institut d'Investigacio Biomedica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Christelle Ferrá
- Hematology Department, Institut Català d'Oncologia-Badalona, Hospital Universitari Germans Trias I Pujol, Josep Carreras Leukemia Research Institute,, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Carme Talarn
- Hospital Universitari Joan XXIII, Tarragona, Spain
| | - Maite Encuentra
- Clinical Hematology Department, Institut Català d'Oncologia, L'Hospitalet, Institut d'Investigacio Biomedica de Bellvitge (IDIBELL), Barcelona, Spain.,Institut Català d'Oncologia, L'Hospitalet, IDIBELL, Barcelona, Spain
| | - Eduard Fort
- Pharmacy Department, Institut Català d'Oncologia, L'Hospitalet, IDIBELL, Barcelona, Spain
| | - David López
- Pharmacy Department, Institut Català d'Oncologia, L'Hospitalet, IDIBELL, Barcelona, Spain
| | - Mireia Morgades
- Hematology Department, Institut Català d'Oncologia-Badalona, Hospital Universitari Germans Trias I Pujol, Josep Carreras Leukemia Research Institute,, Universitat Autònoma de Barcelona, Barcelona, Spain.,Institut Català d'Oncologia, L'Hospitalet, IDIBELL, Barcelona, Spain
| | - Eva Alonso
- Banc de Sang I Teixits de Catalunya, Barcelona, Spain
| | - Sandra Ortega
- Banc de Sang I Teixits de Catalunya, Barcelona, Spain
| | - Josep Sarrá
- Hospital Universitari Joan XXIII, Tarragona, Spain
| | | | - Josep M Ribera
- Hematology Department, Institut Català d'Oncologia-Badalona, Hospital Universitari Germans Trias I Pujol, Josep Carreras Leukemia Research Institute,, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Sureda
- Clinical Hematology Department, Institut Català d'Oncologia, L'Hospitalet, Institut d'Investigacio Biomedica de Bellvitge (IDIBELL), Barcelona, Spain
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Wicherska-Pawłowska K, Rybka J, Prajs I, Szmigiel K, Tyc J, Frączak E, Biedroń M, Kalicińska E, Szymczak D, Wróbel T. The comparison of effectiveness and safety between different biosimilars of G-CSF in the mobilization of peripheral blood stem cells (PBSCs) for autologous transplantation (autologous peripheral blood stem cell transplantation, auto-PBSCT). J Clin Apher 2019; 35:4-8. [PMID: 31663634 DOI: 10.1002/jca.21750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 08/17/2019] [Accepted: 09/07/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Autologous peripheral blood marrow stem cell transplantation (auto-PBSCT) preceded by high-dose chemotherapy is a well-known method of treatment for patients with hematological cancers. Performing the procedure entails obtaining from the patient their own stem cells from peripheral blood using G-CSF. Currently, various filgrastim biosimilars are widely used. AIM OF THE STUDY The purpose of this study is to compare the efficacy and safety of three different biosimilars of filgrastim in PBSC mobilization in patients with hematological malignancies. MATERIALS AND METHODS This is a retrospective analysis of 282 patients (118 women and 164 men) who underwent stem cells mobilization for auto-PBSCT in the Department of Hematology in Wroclaw in 2012-2014. Three filgrastim biosimilars were used: Tevagrastim (95), Nivestim (92), and Zarzio (95). Ninety patients (32%) were diagnosed with multiple myeloma, 55 (19%) with Hodgkin's lymphoma, 90 (32%) with NHLs, 20 (7%) with acute myeloid leukemia, and 27 (10%) with another hematological cancer. RESULTS The mean number of CD34+ cells collected during the first leukapheresis was 5.95 × 106 /kg for Tevagrastim, 7.08 × 106 /kg for Nivestim, and 6.8 × 106 /kg for Zarzio (P > .05). The necessary number of leukapheresis for patients receiving Zarzio, Nivestim, and Tevagrastim was 1.32, 1.37, and 1.66, respectively (P > .05). The percentage of effective mobilizations was 88.2% for Zarzio, 86.2% for Nivestim, and 84.9% for Tevagrastim. The side effects included bone pain and headache. CONCLUSION All tested biosimilars demonstrated similar effectiveness and safety profiles in patients with hematological tumors undergoing PBSC mobilization; therefore, they can be used interchangeably.
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Affiliation(s)
- Katarzyna Wicherska-Pawłowska
- Department of Hematology, Blood Cancer and Bone Marrow Transplantation, Wroclaw University Hospital, Wroclaw, Lower Silesia, Poland.,Wroclaw Medical University, Wroclaw, Lower Silesia, Poland
| | - Justyna Rybka
- Department of Hematology, Blood Cancer and Bone Marrow Transplantation, Wroclaw University Hospital, Wroclaw, Lower Silesia, Poland.,Wroclaw Medical University, Wroclaw, Lower Silesia, Poland
| | - Iwona Prajs
- Department of Hematology, Blood Cancer and Bone Marrow Transplantation, Wroclaw University Hospital, Wroclaw, Lower Silesia, Poland
| | | | - Joanna Tyc
- Wroclaw Medical University, Wroclaw, Lower Silesia, Poland
| | - Ewa Frączak
- Department of Hematology, Blood Cancer and Bone Marrow Transplantation, Wroclaw University Hospital, Wroclaw, Lower Silesia, Poland
| | - Monika Biedroń
- Department of Hematology, Blood Cancer and Bone Marrow Transplantation, Wroclaw University Hospital, Wroclaw, Lower Silesia, Poland
| | - Elżbieta Kalicińska
- Department of Hematology, Blood Cancer and Bone Marrow Transplantation, Wroclaw University Hospital, Wroclaw, Lower Silesia, Poland
| | - Donata Szymczak
- Department of Hematology, Blood Cancer and Bone Marrow Transplantation, Wroclaw University Hospital, Wroclaw, Lower Silesia, Poland
| | - Tomasz Wróbel
- Department of Hematology, Blood Cancer and Bone Marrow Transplantation, Wroclaw University Hospital, Wroclaw, Lower Silesia, Poland.,Wroclaw Medical University, Wroclaw, Lower Silesia, Poland
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Buyukavci M, Yildirim ZK. The Comparison of The Efficacy and Safety of Original and Biosimilar Filgrastim in Prevention of Chemotherapy-Induced Neutropenia in Children with Cancer. Eurasian J Med 2019; 51:112-115. [PMID: 31258348 DOI: 10.5152/eurasianjmed.2018.18030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective In adults and children, the duration of chemotherapy-induced neutropenia and associated complications has decreased because of the prophylactic use of granulocyte colony-stimulating factors (G-CSFs). Biosimilar G-CSFs can play an important role in reducing treatment costs in daily practice. However, some concerns regarding the efficacy and safety of new biosimilar products exist among clinicians. This study compared the efficacy and safety of original and biosimilar filgrastims for the prophylaxis of chemotherapy-induced neutropenia in children. Materials and Methods Thirty children receiving myelosuppressive chemotherapy were enrolled in this study. Filgrastims (5 μg/kg/day) were subcutaneously administered in Group A (biosimilar, Leucostim®; Dem İlaç) and Group B (original drug, Neupogen®; Roche). Hemoglobin, white blood cell (WBC) count, platelet count, transfusion requirements, duration of hospitalization, and frequency and duration of adverse events including fever, neutropenia, and mucositis were evaluated following 25 treatment cycles in both groups. Results The hemoglobin value, WBC count, and platelet count on days 1, 5, and 10, and the red blood cell and platelet transfusion requirements, frequency, duration, and severity of mucositis, and durations of fever, febrile neutropenia, and hospitalization were similar in both groups. Although the mean WBC counts on days 1 and 5 were lower in Group A, the difference was statistically insignificant. Conclusion The biosimilar filgrastim, Leucostim, is as effective and safe as the original drug for prophylaxis of chemotherapy-induced neutropenia in children.
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Affiliation(s)
- Mustafa Buyukavci
- Department of Pediatric Oncology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Zuhal Keskin Yildirim
- Department of Pediatric Oncology, Atatürk University School of Medicine, Erzurum, Turkey
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Gómez‐De León A, Bugarin‐Estrada E, Colunga‐Pedraza PR, Colunga‐Pedraza JE, Salazar‐Riojas R, Valdés‐Galván M, López‐García YK, López‐Garza M, Gutiérrez‐Aguirre CH, Cantú‐Rodríguez OG, Mancías‐Guerra C, González‐Llano O, Gómez‐Almaguer D. Efficacy of three filgrastim‐intended copies for hematopoietic stem cell mobilization in healthy adult and pediatric donors in Mexico. J Clin Apher 2019; 34:537-544. [DOI: 10.1002/jca.21707] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 03/25/2019] [Accepted: 03/25/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Andrés Gómez‐De León
- Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Hematology DepartmentUniversidad Autónoma de Nuevo León Monterrey Nuevo León Mexico
| | - Emmanuel Bugarin‐Estrada
- Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Hematology DepartmentUniversidad Autónoma de Nuevo León Monterrey Nuevo León Mexico
| | - Perla R. Colunga‐Pedraza
- Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Hematology DepartmentUniversidad Autónoma de Nuevo León Monterrey Nuevo León Mexico
| | - Julia E. Colunga‐Pedraza
- Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Hematology DepartmentUniversidad Autónoma de Nuevo León Monterrey Nuevo León Mexico
| | - Rosario Salazar‐Riojas
- Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Hematology DepartmentUniversidad Autónoma de Nuevo León Monterrey Nuevo León Mexico
| | - Mayra Valdés‐Galván
- Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Hematology DepartmentUniversidad Autónoma de Nuevo León Monterrey Nuevo León Mexico
| | - Yadith K. López‐García
- Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Hematology DepartmentUniversidad Autónoma de Nuevo León Monterrey Nuevo León Mexico
| | - Mariana López‐Garza
- Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Hematology DepartmentUniversidad Autónoma de Nuevo León Monterrey Nuevo León Mexico
| | - César H. Gutiérrez‐Aguirre
- Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Hematology DepartmentUniversidad Autónoma de Nuevo León Monterrey Nuevo León Mexico
| | - Olga G. Cantú‐Rodríguez
- Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Hematology DepartmentUniversidad Autónoma de Nuevo León Monterrey Nuevo León Mexico
| | - Consuelo Mancías‐Guerra
- Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Hematology DepartmentUniversidad Autónoma de Nuevo León Monterrey Nuevo León Mexico
| | - Oscar González‐Llano
- Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Hematology DepartmentUniversidad Autónoma de Nuevo León Monterrey Nuevo León Mexico
| | - David Gómez‐Almaguer
- Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Hematology DepartmentUniversidad Autónoma de Nuevo León Monterrey Nuevo León Mexico
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Abstract
The recombinant G-CSF filgrastim was first approved in 1991, and its value has been evolving ever since. Initial health technology assessments suggested low value due to high drug cost and no evidence for significant gain in overall survival. However, more recent meta-analyses of placebo-controlled randomized trial data show falling costs due to biosimilar competition and absolute overall survival gains of 3.2% (95% CI: 2.1-4.2%) from filgrastim support of cytotoxic chemotherapy. The launch of biosimilar alternatives merits a re-evaluation of decisions by health technology assessments and explains the first inclusion of filgrastim in the WHO Essential Drug List for cancer >20 years after its original approval in 1991, thus demonstrating the power of biosimilar medicines in transforming healthcare.
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Torres-Acosta MA, Harrison RP, Csaszar E, Rito-Palomares M, Brunck MEG. Ex vivo Manufactured Neutrophils for Treatment of Neutropenia-A Process Economic Evaluation. Front Med (Lausanne) 2019; 6:21. [PMID: 30881955 PMCID: PMC6405517 DOI: 10.3389/fmed.2019.00021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 01/23/2019] [Indexed: 01/11/2023] Open
Abstract
Neutropenia is a common side-effect of acute myeloid leukemia (AML) chemotherapy characterized by a critical drop in neutrophil blood concentration. Neutropenic patients are prone to infections, experience poorer clinical outcomes, and require expensive medical care. Although transfusions of donor neutrophils are a logical solution to neutropenia, this approach has not gained clinical traction, primarily due to challenges associated with obtaining sufficiently large numbers of neutrophils from donors whilst logistically managing their extremely short shelf-life. A protocol has been developed that produces clinical-scale quantities of neutrophils from hematopoietic stem and progenitor cells (HSPC) in 10 L single-use bioreactors (1). This strategy could be used to mass produce neutrophils and generate sufficient cell numbers to allow decisive clinical trials of neutrophil transfusion. We present a bioprocess model for neutrophil production at relevant clinical-scale. We evaluated two production scenarios, and the impact on cost of goods (COG) of multiple model parameters including cell yield, materials costs, and process duration. The most significant contributors to cost were consumables and raw materials, including the cost of procuring HSPC-containing umbilical cord blood. The model indicates that the most cost-efficient culture volume (batch size) is ~100 L in a single bioreactor. This study serves as a framework for decision-making and optimization strategies when contemplating the production of clinical quantities of cells for allogeneic therapy.
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Affiliation(s)
| | - Richard P Harrison
- Centre for Biological Engineering, Holywell Park, Loughborough University, Loughborough, United Kingdom.,Wolfson Centre for Stem Cells, Tissue Engineering and Modelling (STEM), School of Medicine, Nottingham, United Kingdom
| | - Elizabeth Csaszar
- Centre for Commercialization of Regenerative Medicine, Toronto, ON, Canada
| | - Marco Rito-Palomares
- Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Monterrey, Mexico
| | - Marion E G Brunck
- Centro de Biotecnología FEMSA, Tecnológico de Monterrey, Monterrey, Mexico
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Busse A, Lüftner D. What Does the Pipeline Promise about Upcoming Biosimilar Antibodies in Oncology? Breast Care (Basel) 2019; 14:10-16. [PMID: 31019437 PMCID: PMC6465746 DOI: 10.1159/000496834] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The introduction of biosimilars of biological agents for which the patents and exclusivity periods have expired is an attractive way of reducing healthcare spending through price competition with the reference product. In oncology, biosimilars of growth factors for supportive therapy were the pioneers; now, monoclonal antibody biosimilars are conquering the market. In Europe, this is currently limited to biosimilars of the monoclonal antibodies trastuzumab and rituximab. However, the pipeline is full and several monoclonal antibody biosimilars in oncology are now in late-stage development. We are expecting not only more biosimilar versions of the top 3 blockbuster monoclonal antibodies, trastuzumab, rituximab and bevacizumab, to enter the market; as patent expiration of multiple other cancer biologicals will occur in the next few years, the biosimilar landscape will become much more diversified. Several biosimilars of monoclonal antibodies used in targeted therapy such as cetuximab, pertuzumab, or denosumab are in early development.
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Affiliation(s)
- Antonia Busse
- Medical Department of Hematology, Oncology and Tumor Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
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Roché H, Eymard JC, Radji A, Prevost A, Diab R, Lamuraglia M, Soumoudronga RF, Gasnereau I, Toledano A. Biosimilar filgrastim treatment patterns and prevention of febrile neutropenia: a prospective multicentre study in France in patients with solid tumours (the ZOHé study). BMC Cancer 2018; 18:1127. [PMID: 30445935 PMCID: PMC6240200 DOI: 10.1186/s12885-018-4986-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 10/23/2018] [Indexed: 11/17/2022] Open
Abstract
Background The ZOHé study was a prospective, non-interventional, multicentre study in France to assess the use of biosimilar filgrastim Zarzio® (Sandoz filgrastim) in routine clinical practice in patients at risk of neutropenia-inducing chemotherapy (CT). Methods Patients ≥ 18 years undergoing CT for a malignant disease and with a first prescription for Zarzio® were enrolled in two cohorts according to tumour type: solid tumour or haematological malignancy; results from the solid tumour cohort are reported here. Analyses primarily described the prescription and use of Zarzio® in current practice, and also included identification of factors linked to prescription for primary prophylaxis and comparison of Zarzio® use in relation to European Organisation for Research and Treatment of Cancer (EORTC) guidelines. Results Responses were obtained from 125 physicians and 1179 patients with solid tumours, allowing robust statistical analysis of the data. Use of Zarzio® in clinical practice was relatively standardised and followed label indication. The patient profile was in line with EORTC guidelines for granulocyte colony-stimulating factor (G-CSF) febrile neutropenia (FN) prophylaxis, and the majority of patients had ≥ 1 EORTC factor(s) for increased risk of febrile neutropenia. Some patients (10.8%) received Zarzio® despite receiving CT regimens categorised in guidelines as low (< 10%) FN risk (‘over prophylaxis’). Nearly half of patients’ CT regimens did not have a recommended FN risk category. Zarzio® was commonly initiated as primary prophylaxis; initiation in Cycle ≥ 2 of the current line of CT was associated more with a history of neutropenia. The safety profile of Zarzio® was confirmed. Conclusions Use of Zarzio® in routine clinical practice is generally in line with EORTC guidelines for prophylaxis of CT-induced neutropenia. Patient-related risk factors appear to be a stronger driver of clinicians’ decision to initiate Zarzio® than CT risk category for FN. The intrinsic risk of FN associated with a specific CT protocol is often miscategorised by physicians. In contrast to earlier reports of underuse of G-CSF prophylaxis, over prophylaxis is observed in a small subgroup of patients with FN risk of < 10%. Electronic supplementary material The online version of this article (10.1186/s12885-018-4986-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Henri Roché
- Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse - Oncopole, 1 avenue Irène Joliot-Curie, 31059, Toulouse Cedex 9, France.
| | | | | | | | - Rafik Diab
- Centre Médical Spécialisé de Praz-Coutant, Passy, Paris, France
| | - Michele Lamuraglia
- Assistance Publique Hôpitaux de Paris - Hôpital Beaujon, Clichy, Paris, France
| | | | | | - Alain Toledano
- Institut de Cancerologie Hartmann, Levallois-Perret, France
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Patel KB, Arantes LH, Tang WY, Fung S. The role of biosimilars in value-based oncology care. Cancer Manag Res 2018; 10:4591-4602. [PMID: 30410395 PMCID: PMC6199968 DOI: 10.2147/cmar.s164201] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Biopharmaceuticals (biologics) represent one of the fastest growing sectors of cancer treatment. They are recommended for treating underlying cancer and as supportive care for management of treatment side effects. Given the high costs of cancer care and the need to balance health care provision and associated budgets, patient access and value are the subject of discussion and debate in the USA and globally. As the costs of biologics are high, biosimilars offer the potential of greater choice and value, increased patient access to treatment, and the potential for improved outcomes. Value-based care aims to improve the quality of care, while containing costs. The Centers for Medicare & Medicaid Services (CMS) has developed value-based care programs as alternatives to fee-for-service reimbursement, including in oncology, that reward health care providers with incentive payments for improving the quality of care they provide. It is anticipated that CMS payments in oncology care will be increasingly tied to measured performance. This review provides an overview of value-based care models in oncology with a focus on CMS programs and discusses the contribution of biosimilars to CMS value-based care objectives. Biosimilars may provide an important tool for providers participating in value-based care initiatives, resulting in cost savings and efficiencies in the delivery of high-value care through expanded use of biologic treatment and supportive care agents during episodes of cancer care.
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Affiliation(s)
| | - Luiz H Arantes
- Biosimilars Global Medical Affairs, Pfizer Essential Health, Pfizer Inc. New York, NY, USA
| | - Wing Yu Tang
- Health Economics and Outcomes Research, Pfizer Health & Impact, Pfizer Essential Health, Pfizer Inc. New York, NY, USA
| | - Selwyn Fung
- Pfizer Essential Health Research & Development, Pfizer Inc. New York, NY, USA,
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Schwartzberg LS, Lal LS, Balu S, Campbell K, Brekke L, Elliott C, Korrer S. Incidence of febrile neutropenia during chemotherapy among patients with nonmyeloid cancer receiving filgrastim vs a filgrastim biosimilar. CLINICOECONOMICS AND OUTCOMES RESEARCH 2018; 10:493-500. [PMID: 30214262 PMCID: PMC6126503 DOI: 10.2147/ceor.s168298] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Filgrastim and other granulocyte colony-stimulating factors are recommended to decrease febrile neutropenia (FN) incidence among patients with nonmyeloid cancers undergoing chemotherapy. Data comparing biosimilar filgrastim-sndz with reference filgrastim (filgrastim-ref) are limited outside of clinical trials in the US. Objective To compare the incidence of FN across chemotherapy cycles 1-6 between patients treated with filgrastim-sndz vs filgrastim-ref. Materials and methods This was a retrospective claims analysis of patients with nonmyeloid cancer enrolled in commercial or Medicare Advantage plans from March 2015 to June 2016 and receiving filgrastim-sndz or filgrastim-ref during ≥1 completed chemotherapy cycle. Patients undergoing hematopoietic stem cell transplantation, pregnant patients, and those with missing data were excluded. FN was identified using the diagnosis codes for neutropenia + fever, neutropenia + bacterial/fungal infection, and neutropenia + infection + fever. Equivalence testing for FN incidence at the cycle level across chemotherapy cycles 1-6 was conducted for filgrastim-sndz vs filgrastim-ref after adjusting for baseline characteristics using inverse probability of treatment weighting. Results were considered equivalent if the 90% CIs for between-cohort differences were within ±6.0%. Results The analysis included 3,459 patients (162 filgrastim-sndz and 3,297 filgrastim-ref). Before weighting, the filgrastim-sndz cohort was younger than filgrastim-ref and had a higher proportion of men, a higher proportion with commercial insurance, and lower proportions with granulocyte colony-stimulating factor prophylaxis or metastatic cancer. After weighting, baseline characteristics were similar between cohorts. Adjusted FN incidence was equivalent for filgrastim-sndz vs filgrastim-ref, respectively: neutropenia + fever, 0.81% vs 0.61% (difference [90% CI]=0.20 [-0.57 to 1.56]); neutropenia + infection, 1.21% vs 1.33% (difference [90% CI]=-0.12 [-1.17 to 2.28]); neutropenia + infection + fever, 0.0% vs 0.14% (difference=-0.14; CI not calculated because filgrastim-sndz had 0 events). Conclusion Filgrastim-sndz and filgrastim-ref are statistically equivalent for preventing FN across chemotherapy cycles 1-6 among patients with nonmyeloid cancer.
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Affiliation(s)
- Lee S Schwartzberg
- West Cancer Center, Memphis, TN, USA.,Division of Hematology and Oncology, University of Tennessee, Memphis, TN, USA
| | - Lincy S Lal
- Health Economics and Outcomes Research, Optum, Eden Prairie, MN, USA,
| | - Sanjeev Balu
- US Clinical Development and Medical Affairs, Sandoz Inc., Princeton, NJ, USA
| | - Kim Campbell
- US Clinical Development and Medical Affairs, Sandoz Inc., Princeton, NJ, USA
| | - Lee Brekke
- Health Economics and Outcomes Research, Optum, Eden Prairie, MN, USA,
| | - Caitlin Elliott
- Health Economics and Outcomes Research, Optum, Eden Prairie, MN, USA,
| | - Stephanie Korrer
- Health Economics and Outcomes Research, Optum, Eden Prairie, MN, USA,
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Long-term treatment with biosimilar epoetin-α (HX575) in hemodialysis patients with renal anemia: real-world effectiveness and safety in the MONITOR-CKD5 study
. Clin Nephrol 2018; 89 (2018):1-9. [PMID: 29168688 PMCID: PMC5735817 DOI: 10.5414/cn109245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2017] [Indexed: 11/18/2022] Open
Abstract
Aims: To assess real-world effectiveness and safety of intravenous (IV) HX575, a biosimilar epoetin-α, in hemodialysis (HD) patients. Materials and methods: This prospective, observational, pharmacoepidemiological study of adult HD patients treated with IV HX575 for renal anemia for up to 24 months was conducted in 114 centers in 10 European countries. Of 2,086 enrolled subjects (safety sample), 2,023 had ≥ 1 follow-up visit (effectiveness sample). Results: Most (59.3%) patients were male, median age was 68 years. At enrollment, most (82.5%) had been treated with an erythropoiesis-stimulating agent, and 73.0% had adequate iron stores. At baseline, mean (± standard deviation) baseline hemoglobin (Hb) was 11.09 (± 1.14) g/dL and HX575 dose 106.5 (± 78.7) international units (IU)/kg/week; at month 24, Hb was 11.25 (± 1.19) g/dL and HX575 dose 113.0 (± 102.5) IU/kg/week. Variations in mean HX575 dose and Hb over the study were not statistically significant. As to safety, 140 patients (6.7%) experienced ≥ 1 adverse event; of these, 19 events (16 patients; 0.8%) were related to HX575 treatment, 148 (108 patients; 5.2%) were reported as serious, including 12 events in 11 patients (0.5%) stated to be related. No cases of anti-epoetin antibodies or pure red cell aplasia were reported. Conclusions: MONITOR-CKD5 confirmed the real-world effectiveness and safety profile of IV biosimilar HX575. HD patients treated for up to 24 months showed stable dosing patterns and Hb outcomes. The safety profile of HX575 is likewise comparable to reference epoetin-α.
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McBride A, Campbell K, Bikkina M, MacDonald K, Abraham I, Balu S. Reply: Cost-efficiency analyses for the US of biosimilar filgrastim-sndz, reference filgrastim, pegfilgrastim, and pegfilgrastim with on-body injector in the prophylaxis of chemotherapy-induced (febrile) neutropenia. J Med Econ 2018; 21:606-609. [PMID: 29561198 DOI: 10.1080/13696998.2018.1452749] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Ali McBride
- a Banner University Medical Center , Tucson , AZ , USA
- b University of Arizona Cancer Center , Tucson , AZ , USA
- c Department of Pharmacy Practice and Science , College of Pharmacy, University of Arizona , Tucson , AZ , USA
| | | | | | | | - Ivo Abraham
- b University of Arizona Cancer Center , Tucson , AZ , USA
- c Department of Pharmacy Practice and Science , College of Pharmacy, University of Arizona , Tucson , AZ , USA
- e Matrix45 , Tucson , AZ , USA
- f Center for Health Outcomes and PharmacoEconomic Research, University of Arizona , Tucson , AZ , USA
- g Department of Family and Community Medicine , College of Medicine-Tucson, University of Arizona , Tucson , AZ , USA
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Blackwell K, Gascon P, Jones CM, Nixon A, Krendyukov A, Nakov R, Li Y, Harbeck N. Pooled analysis of two randomized, double-blind trials comparing proposed biosimilar LA-EP2006 with reference pegfilgrastim in breast cancer. Ann Oncol 2018. [PMID: 28637287 PMCID: PMC5834021 DOI: 10.1093/annonc/mdx303] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Following the functional and physicochemical characterization of a proposed biosimilar, comparative clinical studies help to confirm biosimilarity by demonstrating similar safety and efficacy to the reference product in a sensitive patient population. Patients and methods LA-EP2006 is a proposed biosimilar that has been developed for pegfilgrastim, a long-acting form of granulocyte colony-stimulating factor for the prevention of neutropenia. The current analysis reports data pooled from two independent, multinational, prospective, randomized, controlled, double-blind phase III studies of similar design comparing the safety and efficacy of reference pegfilgrastim with LA-EP2006 in patients with breast cancer receiving myelotoxic (neo)adjuvant TAC (docetaxel, doxorubicin, and cyclophosphamide) chemotherapy and requiring granulocyte colony-stimulating factor. Results A total of 624 patients were randomized in the PROTECT-1 and PROTECT-2 studies (NCT01735175; NCT01516736) (LA-EP2006: n = 314; reference: n = 310). Baseline characteristics of patients were well balanced across treatment groups. The primary end point, mean duration of severe neutropenia in the first chemotherapy cycle was similar in both the LA-EP2006 and reference groups (1.05 ± 1.055 days versus 1.01 ± 0.958 days), with a treatment difference of - 0.04 days [95% confidence interval (CI): -0.19 to 0.11] that met the equivalence criteria (the 95% CI were within the defined margin of ±1 day). Secondary end points, such as the nadir of absolute neutrophil count and the incidence of febrile neutropenia, were also similar between LA-EP2006 and reference pegfilgrastim. The safety and tolerability profile of LA-EP2006 was similar to that observed with reference pegfilgrastim, and there were no reports of neutralizing antibodies. Conclusions This pooled analysis confirms, as a part of totality of evidence approach, that the proposed biosimilar pegfilgrastim LA-EP2006 has a comparable efficacy and safety profile to reference pegfilgrastim in patients with breast cancer receiving TAC chemotherapy. Clinical trial numbers NCT01735175 and NCT01516736.
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Affiliation(s)
- K Blackwell
- Department of Oncology, Duke University, DUMC, Durham, USA
| | - P Gascon
- Medical Oncology Department, Hospital General Vall d'Hebron, Barcelona, Spain
| | | | - A Nixon
- Fowler Family Center for Cancer Care, Jonesboro, USA
| | | | - R Nakov
- Hexal AG, Holzkirchen/Oberhaching, Germany
| | - Y Li
- Sandoz Inc., Princeton, USA
| | - N Harbeck
- Breast Center, Department of Obstetrics and Gynecology, and CCCLMU, University of Munich (LMU), Munich, Germany
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Schwartzberg LS, Lal LS, Balu S, Campbell K, Brekke L, DeLeon A, Elliott C, Korrer S. Clinical Outcomes of Treatment with Filgrastim Versus a Filgrastim Biosimilar and Febrile Neutropenia-Associated Costs Among Patients with Nonmyeloid Cancer Undergoing Chemotherapy. J Manag Care Spec Pharm 2018; 24:976-984. [PMID: 29687743 PMCID: PMC10397873 DOI: 10.18553/jmcp.2018.17447] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Granulocyte colony-stimulating factors such as filgrastim are used to decrease the incidence of febrile neutropenia (FN) among patients with nonmyeloid cancers undergoing chemotherapy treatment. Although the biosimilar filgrastim-sndz has been approved in the United States since 2015, limited real-world comparisons of filgrastim-sndz versus reference filgrastim (filgrastim-ref) have been conducted. OBJECTIVE To compare FN incidence and assess overall FN-related health care resource utilization and medical costs among U.S. patients with non-myeloid cancer who received filgrastim-sndz or filgrastim-ref during their first chemotherapy cycle. METHODS This was a retrospective claims analysis of patients with non-myeloid cancer who were enrolled in commercial or Medicare Advantage insurance plans from March 2015 through June 2016 and received filgrastim-sndz or filgrastim-ref during their first observed chemotherapy cycle. Patients with evidence of hematopoietic stem cell transplantation or pregnancy and those with missing demographic information were excluded. FN was defined on the basis of diagnosis codes for neutropenia and fever (N/F); neutropenia and infection (N/I); and neutropenia, infection, and fever (N/I/F). Cohorts were adjusted for differences in baseline patient characteristics using the inverse probability of treatment weighting (IPTW) method, and equivalence testing was used to compare the proportion of patients who developed FN between weighted cohorts. On the basis of the range of neutropenic fever incidence found in the PIONEER clinical trial, FN incidence was considered equivalent if 90% CIs for between-cohort differences were within ± 6%. Mean FN-related health care resource utilization and total FN-related medical costs were calculated for the overall study population. RESULTS A total of 3,542 patients were included in the study (172 filgrastim-sndz; 3,370 filgrastim-ref; mean ages 62.1 years and 64.7 years, respectively). After IPTW, there were 162 patients in the filgrastim-sndz cohort and 3,297 in the filgrastim-ref cohort (mean age 64.5 years for both). FN incidence in the weighted filgrastim-sndz versus filgrastim-ref cohorts, respectively, was 1.4% versus 0.9% for N/F, 2.3% versus 1.7% for N/I, and 0.0% versus 0.3% for N/I/F; FN incidence was statistically equivalent between treatment cohorts. Among patients in either treatment cohort who developed FN, the proportion with FN-related inpatient stays during the first chemotherapy cycle ranged from 35.0% for N/I to 70.0% for N/I/F. Mean (SD) FN-related total medical costs across all patients who developed FN were $11,977 ($18,383) for N/F, $8,040 ($14,809) for N/I, and $21,733 ($30,003) for N/I/F, in 2015 U.S. dollars. For all 3 definitions of FN, the largest proportions (73.5%-93.4%) of medical costs were inpatient related. CONCLUSIONS In this real-world study of patients with nonmyeloid cancers undergoing chemotherapy, the incidence of FN was statistically equivalent between individuals treated with filgrastim-sndz versus filgrastim-ref during their first chemotherapy cycle. FN-related health care resource utilization and medical costs among patients who developed FN were substantial. DISCLOSURES This work was funded by Sandoz, which participated in the study design, data interpretation, writing and revision of the manuscript, and decision to submit the manuscript for publication. Balu and Campbell are employees of Sandoz, which is the manufacturer of the filgrastim biosimilars Zarzio and Zarxio. DeLeon was an employee of Sandoz at the time this study was conducted. Lal, Brekke, Elliott, and Korrer are employees of Optum, which was contracted by Sandoz to conduct this study.
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Esteva FJ, Stebbing J, Wood-Horrall RN, Winkle PJ, Lee SY, Lee SJ. A randomised trial comparing the pharmacokinetics and safety of the biosimilar CT-P6 with reference trastuzumab. Cancer Chemother Pharmacol 2018; 81:505-514. [DOI: 10.1007/s00280-017-3510-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 12/28/2017] [Indexed: 01/07/2023]
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Harbeck N, Gascón P, Krendyukov A, Hoebel N, Gattu S, Blackwell K. Safety Profile of Biosimilar Filgrastim (Zarzio/Zarxio): A Combined Analysis of Phase III Studies. Oncologist 2018; 23:403-409. [PMID: 29317553 DOI: 10.1634/theoncologist.2017-0348] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 11/30/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Evaluation of adverse events (AEs) in pivotal registration trials and ongoing postmarketing surveillance is important for all biologics, including biosimilars. A combined analysis of two pivotal registration studies was performed to strengthen evidence on safety for biosimilar filgrastim EP2006 in patients with breast cancer receiving myelosuppressive chemotherapy, a sensitive clinical setting to confirm biosimilarity of filgrastim. MATERIALS AND METHODS Data were combined from two phase III studies of biosimilar filgrastim EP2006. The U.S. registration study was a randomized, double-blind comparison of biosimilar and reference filgrastim in women aged ≥18 years with breast cancer, receiving (neo)adjuvant treatment with TAC (docetaxel + doxorubicin + cyclophosphamide). The European Union registration study was a single-arm, open-label study of biosimilar filgrastim in women aged ≥18 years with breast cancer receiving doxorubicin + docetaxel. Patients received filgrastim as a subcutaneous injection on day 2 of each cycle for <14 days or until the absolute neutrophil count reached 10 × 109/L after the expected nadir. Results were combined for cycles 1-4. RESULTS A total of 277 patients received biosimilar filgrastim EP2006. Patients had a mean (± standard deviation) age of 51.1 (± 10.8) years, and 78.7% of patients had stage II or III breast cancer. A total of 46 (20.6%) patients receiving biosimilar filgrastim had AEs considered filgrastim-related. The most frequently reported filgrastim-related AEs were musculoskeletal or connective tissue disorders (15.2%), including bone pain (7.2%). One death (due to pulmonary embolism) occurred of a patient receiving biosimilar filgrastim (not considered filgrastim-related). No patient developed antidrug antibodies during the study. CONCLUSION Biosimilar filgrastim has a safety profile consistent with previous filgrastim studies and is effective in preventing febrile neutropenia in patients with breast cancer. IMPLICATIONS FOR PRACTICE The biosimilar filgrastim EP2006 (Zarzio, Zarxio, biosimilar filgrastim-sndz) has been approved in Europe since 2009 and in the U.S. since 2015. This combined analysis of two phase III studies provides additional clinical evidence that the biosimilar filgrastim EP2006 has a safety profile consistent with previous studies of reference filgrastim and supports large postmarketing studies of EP2006 in Europe. Strengthening the evidence for biosimilar filgrastim can help improve acceptance of biosimilars and increase patient access to biologics.
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Affiliation(s)
- Nadia Harbeck
- Brustzentrum der Universität München (LMU), Munich, Germany
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Comparing granulocyte colony–stimulating factor filgrastim and pegfilgrastim to its biosimilars in terms of efficacy and safety: A meta-analysis of randomised clinical trials in breast cancer patients. Eur J Cancer 2018; 89:49-55. [DOI: 10.1016/j.ejca.2017.10.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 10/31/2017] [Indexed: 12/27/2022]
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Affiliation(s)
| | - Matti Aapro
- Multidisciplinary Oncology Institute, Clinique de Genolier, Genolier, Switzerland
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McBride A, Campbell K, Bikkina M, MacDonald K, Abraham I, Balu S. Cost-efficiency analyses for the US of biosimilar filgrastim-sndz, reference filgrastim, pegfilgrastim, and pegfilgrastim with on-body injector in the prophylaxis of chemotherapy-induced (febrile) neutropenia. J Med Econ 2017; 20:1083-1093. [PMID: 28722494 DOI: 10.1080/13696998.2017.1358173] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIMS Guidelines recommend prophylaxis with granulocyte colony-stimulating factor for chemotherapy-induced (febrile) neutropenia (CIN/FN) based on regimen myelotoxicity and patient-related risk factors. The aim was to conduct a cost-efficiency analysis for the US of the direct acquisition and administration costs of the recently approved biosimilar filgrastim-sndz (Zarxio EP2006) with reference to filgrastim (Neupogen), pegfilgrastim (Neulasta), and a pegfilgrastim injection device (Neulasta Onpro; hereafter pegfilgrastim-injector) for CIN/FN prophylaxis. METHODS A cost-efficiency analysis of the prophylaxis of one patient during one chemotherapy cycle under 1-14 days' time horizon was conducted using the unit dose average selling price (ASP) and Current Procedural Terminology (CPT) codes for subcutaneous prophylactic injection under four scenarios: cost of medication only (COSTMED), patient self-administration (SELFADMIN), healthcare provider (HCP) initiating administration followed by self-administration (HCPSTART), and HCP providing full administration (HCPALL). Two case studies were created to illustrate real-world clinical implications. The analyses were replicated using wholesale acquisition cost (WAC). RESULTS Using ASP + CPT, cost savings achieved with filgrastim-sndz relative to reference filgrastim ranged from $65 (1 day) to $916 (14 days) across all scenarios. Relative to pegfilgrastim, savings with filgrastim-sndz ranged from $834 (14 days) up to $3,666 (1 day) under the COSTMED, SELFADMIN, and HPOSTART scenarios; and from $284 (14 days) up to $3,666 (1 day) under the HPOALL scenario. Similar to the cost-savings compared to pegfilgrastim, filgrastim-sndz achieved savings relative to pegfilgrastim-injector: from $834 (14 days) to $3,666 (1 day) under the COSTMED scenario, from $859 (14 days) to $3,692 (1 day) under SELFADMIN, from $817 (14 days) to $3,649 (1 day) under HPOSTART, and from $267 (14 days) to $3,649 (1 day) under HPOALL. Cost savings of filgrastim-sndz using WAC + CPT were even greater under all scenarios. CONCLUSIONS Prophylaxis with filgrastim-sndz, a biosimilar filgrastim, was associated consistently with significant cost-savings over prophylaxis with reference filgrastim, pegfilgrastim, and pegfilgrastim-injector, and this across various administration scenarios.
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Affiliation(s)
- Ali McBride
- a Banner University Medical Center , Tucson , AZ , USA
- b University of Arizona Cancer Center , Tucson , AZ , USA
- c Department of Pharmacy Practice and Science, College of Pharmacy , University of Arizona , Tucson , AZ , USA
| | | | | | | | - Ivo Abraham
- b University of Arizona Cancer Center , Tucson , AZ , USA
- c Department of Pharmacy Practice and Science, College of Pharmacy , University of Arizona , Tucson , AZ , USA
- e Matrix45 , Tucson , AZ , USA
- f Center for Health Outcomes and PharmacoEconomic Research , University of Arizona , Tucson , AZ , USA
- g Department of Family and Community Medicine, College of Medicine-Tucson , University of Arizona , Tucson , AZ , USA
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McBride A, Balu S, Campbell K, Bikkina M, MacDonald K, Abraham I. Expanded access to cancer treatments from conversion to neutropenia prophylaxis with biosimilar filgrastim-sndz. Future Oncol 2017; 13:2285-2295. [DOI: 10.2217/fon-2017-0374] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Aim: Biosimilar medicines offer significant cost-savings potential over their reference products, which can be re-allocated to provide access to other cancer treatments on a budget-neutral basis. Methods: Simulation study using cost data for the USA under consideration of several prophylaxis patterns. Results: Potential savings from conversion from reference filgrastim to biosimilar filgrastim-sndz are significant. These savings expand budget-neutral access to novel immunotherapies (obinutuzumab; pembrolizumab) or supportive care (filgrastim-sndz). Conclusion: The combination of biosimilar savings and expanded access increases the value of cancer care as the same supportive care is provided at lower cost, additional cancer care is enabled at no additional cost, and more patients will have access to cancer care.
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Affiliation(s)
- Ali McBride
- Department of Pharmacy, Banner University Medical Center, Tucson, AZ 85719, USA
- Department of Pharmacy, University of Arizona Cancer Center, Tucson, AZ 85719, USA
- Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA
| | | | | | | | | | - Ivo Abraham
- Department of Pharmacy, University of Arizona Cancer Center, Tucson, AZ 85719, USA
- Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA
- Matrix45, Tucson, AZ 85743, USA
- Center for Health Outcomes & PharmacoEconomic Research, University of Arizona, Tucson, AZ 85721, USA
- Department of Family & Community Medicine, College of Medicine – Tucson, University of Arizona, Tucson, AZ 85721, USA
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Dranitsaris G, Jacobs I, Kirchhoff C, Popovian R, Shane LG. Drug tendering: drug supply and shortage implications for the uptake of biosimilars. CLINICOECONOMICS AND OUTCOMES RESEARCH 2017; 9:573-584. [PMID: 29033595 PMCID: PMC5628685 DOI: 10.2147/ceor.s140063] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Due to the continued increase in global spending on health care, payers have introduced a number of programs, policies, and agreements on pharmaceutical pricing in order to control costs. While incentives to increase generic drug use have achieved significant savings, other cost-containment measures are required. Tendering is a formal procedure to purchase medications using competitive bidding for a particular contract. Although useful for cost containment, tendering can lead to decreased competition in a given market. Consequently, drug shortages can occur, resulting in changes to treatment plans to products that may have lower efficacy and/or an increased risk of adverse effects. Therefore, care must be taken to ensure that tendering does not negatively impact patient care or the health care system. A large and expanding portion of total pharmaceutical expenditure is for biologic therapies. These agents have revolutionized the treatment of many diseases, including cancer and inflammatory conditions; however, patient access to biologic drugs can be limited due to availability, insurance coverage, and cost. As branded biologic therapies reach the end of patent- and data-protection periods, biosimilars are being approved as lower-cost alternatives. Biosimilars are products that are highly similar to the originator product with no clinically meaningful differences in terms of safety, purity, or potency. As more biosimilars receive regulatory approval and adoption increases, these therapies are expected to have an impact on global health care spending and should result in overall savings. However, the use of tendering to maximize the potential benefits of biosimilars has varied across the world. Therefore, the objectives of this review are to examine the drug-tendering process and its implications on drug supply and drug shortages, as well as to describe biosimilars and how tendering may influence their uptake.
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Affiliation(s)
| | - Ira Jacobs
- Global Medical Affairs, Pfizer Inc, New York, NY
| | - Carol Kirchhoff
- Global Technology Services, Biotechnology and Aseptic Sciences Group, Pfizer Inc, Chesterfield, MO
| | | | - Lesley G Shane
- Outcomes and Evidence, Global Health and Value, Pfizer Inc, New York, NY, USA
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Inotai A, Prins CPJ, Csanádi M, Vitezic D, Codreanu C, Kaló Z. Is there a reason for concern or is it just hype? - A systematic literature review of the clinical consequences of switching from originator biologics to biosimilars. Expert Opin Biol Ther 2017. [PMID: 28650704 DOI: 10.1080/14712598.2017.1341486] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION While prescribing biosimilars to patients naive to a biologic treatment is a well-accepted practice, switching clinically stable patients from an originator to a biosimilar is an issue for clinicians. Well-designed clinical trials and real-world data which study the consequences of switching from an originator biologic treatment to its biosimilar alternative are limited, especially for monoclonal antibodies. Areas covered: A systematic literature review was conducted on PubMed to identify evidence of the consequences of switching from original biologics to biosimilars. References of included papers were also scrutinized. After a title-, abstract- and full text screening, out of the 153 original hits and 77 additional ones from screening the references, 58 papers (12 empirical papers, 5 systematic reviews and 41 non-empirical papers) were included. Expert opinion: Preventing patients on biologic medicines from switching to biosimilars due to anticipated risks seems to be disproportional compared to the expected cost savings and/or improved patient access. Indeed, it is the opinion of the authors that the concern of switching to biosimilars is overhyped.
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Affiliation(s)
- András Inotai
- a Syreon Research Institute , Budapest , Hungary.,b Department of Health Policy & Health Economics , Faculty of Social Sciences, Eötvös Loránd University (ELTE) Budapest , Hungary
| | - Christiaan P J Prins
- c Department of Pharmaceutical Sciences , Utrecht University , Utrecht , The Netherlands
| | | | - Dinko Vitezic
- d University of Rijeka School of Medicine and University Hospital Centre Rijeka , Rijeka , Croatia
| | - Catalin Codreanu
- e Center for Rheumatic Diseases , University of Medicine and Pharmacy , Bucharest , Romania
| | - Zoltán Kaló
- a Syreon Research Institute , Budapest , Hungary.,b Department of Health Policy & Health Economics , Faculty of Social Sciences, Eötvös Loránd University (ELTE) Budapest , Hungary
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Nasillo V, Paolini A, Riva G, Morselli M, Potenza L, Coluccio V, Maccaferri M, Colaci E, Fantuzzi V, Messerotti A, Arletti L, Pioli V, Lugli E, Gilioli A, Quadrelli C, Zucchini P, Vallerini D, Lagreca I, Barozzi P, Cuoghi A, Bresciani P, Marasca R, Mariano MT, Ceccherelli G, Comoli P, Campioli D, Trenti T, Narni F, Luppi M, Forghieri F. Effectiveness of originator (Neupogen) and biosimilar (Zarzio) filgrastim in autologous peripheral blood stem cell mobilization in adults with acute myeloid leukemia: a single-center retrospective study. Leuk Lymphoma 2017; 59:225-228. [PMID: 28587560 DOI: 10.1080/10428194.2017.1321748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Vincenzo Nasillo
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Ambra Paolini
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Giovanni Riva
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Monica Morselli
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Leonardo Potenza
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Valeria Coluccio
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Monica Maccaferri
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Elisabetta Colaci
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Valeria Fantuzzi
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Andrea Messerotti
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Laura Arletti
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Valeria Pioli
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Elisabetta Lugli
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Andrea Gilioli
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Chiara Quadrelli
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Patrizia Zucchini
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Daniela Vallerini
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Ivana Lagreca
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Patrizia Barozzi
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Angela Cuoghi
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Paola Bresciani
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Roberto Marasca
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Maria Teresa Mariano
- b Immuno-Transfusional Medicine Unit , Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Giovanni Ceccherelli
- b Immuno-Transfusional Medicine Unit , Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Patrizia Comoli
- c Pediatric Hematology Unit , Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo , Pavia , Italy
| | - Daniele Campioli
- d Department of Laboratory Medicine and Pathology , Unità Sanitaria Locale (USL) , Modena , Italy
| | - Tommaso Trenti
- d Department of Laboratory Medicine and Pathology , Unità Sanitaria Locale (USL) , Modena , Italy
| | - Franco Narni
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Mario Luppi
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Fabio Forghieri
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
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Damaj GL, Benbrahim O, Hacini M, Voronina I, Benabed K, Soumoudronga RF, Gasnereau I, Haioun C, Solal-Céligny P. ZOHé: A Prospective Study of the Use of Biosimilar Filgrastim Zarzio in Clinical Practice in Patients Treated With Chemotherapy for Lymphoid Malignancies. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017. [PMID: 28622961 DOI: 10.1016/j.clml.2017.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The ZOHé study was a prospective, observational, multicenter study in France to assess use of biosimilar filgrastim Zarzio in routine clinical practice in patients undergoing neutropenia-inducing chemotherapy. PATIENTS AND METHODS Patients ≥ 18 years undergoing chemotherapy for a malignant disease and with a first prescription for Zarzio were enrolled in 2 cohorts: solid tumor (1174 patients) or hematological malignancy (633 patients); the latter is reported here. Analyses primarily described the prescription and use of Zarzio in current practice, and included identification of factors linked to prescription for primary prophylaxis, comparison of use in relation to European Organisation for the Research and Treatment of Cancer (EORTC) guidelines, and estimation of chemotherapy dose intensity maintenance in patients given Zarzio. RESULTS Use of Zarzio in clinical practice was relatively standardized and followed label indication in 96.7% of the analysis population (633 patients). Most patients had ≥ 2 EORTC patient-related risk factors for febrile neutropenia (FN). Chemotherapy dose intensity was maintained in 85.2% of evaluable patients and 89.6% of patients with non-Hodgkin lymphoma receiving R-CHOP (rituximab-cyclophosphamide/doxorubicin/vincristine/prednisone). The safety profile of Zarzio was confirmed. CONCLUSIONS In routine clinical practice in France, Zarzio is mostly used as primary prophylaxis for chemotherapy-induced neutropenia in patients with hematological malignancies. Patient-related risk factors appear to have more weight in clinicians' decisions to give Zarzio than the FN risk category of the chemotherapy regimen alone in real-world practice.
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Affiliation(s)
- Gandhi Laurent Damaj
- Institut d'hématologie, Centre Hospitalier Universitaire de Caen and Faculté de Médecine, Université de Caen-Normandie, Caen, France
| | | | - Maya Hacini
- Centre Hospitalier Métropole Savoie, Chambéry, France
| | - Inna Voronina
- Centre Hospitalier Boulogne, Boulogne-sur-Mer, France
| | - Khaled Benabed
- Centre Hospitalier Public du Cotentin, Cherbourg-en-Cotentin and Centre Hospitalier Universitaire Côte de Nacre, Caen, France
| | | | | | - Corinne Haioun
- Unité Hémopathies Lymphoïdes, Hôpital Henri Mondor-Albert, Université Paris Est, Créteil, France
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The Rituximab Biosimilar CT-P10 in Rheumatology and Cancer: A Budget Impact Analysis in 28 European Countries. Adv Ther 2017; 34:1128-1144. [PMID: 28397080 PMCID: PMC5427122 DOI: 10.1007/s12325-017-0522-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Indexed: 12/20/2022]
Abstract
Introduction New biosimilars of monoclonal antibodies are anticipated to bring significant cost savings and increase access to treatment. The rituximab biosimilar CT-P10 has recently been approved in Europe in all indications held by reference rituximab (RTX), including rheumatoid arthritis, non-Hodgkin’s lymphoma, and chronic lymphocytic leukemia. We analyzed the budgetary impact of the introduction of CT-P10 into the European Union (EU) for use in patients with rheumatoid arthritis and cancer diagnoses, using a budget impact analysis model. Methods The model used a base case scenario in which the 1-year uptake of CT-P10 was estimated at 30%, and the cost of CT-P10 was assumed to be 70% of the cost of RTX. A second 1-year scenario was also modeled, in which the market share of CT-P10 was assumed to be 50% (scenario 2). Finally, 3-year time horizon outcomes were calculated, in which the market share of CT-P10 was assumed to be 30%, 40%, and 50% in the first, second, and third years, respectively. Results In the base case scenario, the introduction of CT-P10 was associated with projected savings of €90.04 million in the first year, which would allow 7531 additional patients to access rituximab treatment. This was equivalent to a 6.4% increase in the number of rituximab-treated patients. In scenario 2, budget savings were €150.10 million, with a total of 12,551 additional patients able to access rituximab, equivalent to a 10.7% increase. Over a 3-year time horizon, projected budget savings were approximately €570 million, equating to 47,695 additional patients able to access rituximab. Conclusions The model predicted that the introduction of CT-P10 in the EU will be associated with significant budget savings, the reallocation of which will enable many more patients to access rituximab treatment. This is likely to have a significant impact on health gains at patient and societal levels. Funding: CELLTRION Healthcare Co., Ltd. sponsored the development and analysis of the budget impact analysis model. Electronic supplementary material The online version of this article (doi:10.1007/s12325-017-0522-y) contains supplementary material, which is available to authorized users.
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Identification of Low-Level Product-Related Variants in Filgrastim Products Presently Available in Highly Regulated Markets. BioDrugs 2017; 30:233-42. [PMID: 27026103 DOI: 10.1007/s40259-016-0169-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Filgrastim is a recombinant, non-glycosylated form of human granulocyte colony-stimulating factor, used to stimulate leukocyte proliferation in patients suffering from neutropenia. Since the expiration of patents associated with Amgen's filgrastim biopharmaceutical, Neupogen(®), in 2006, a number of filgrastim products have been marketed; however, a detailed characterization and comparison of variants associated with these products have not been publically reported. OBJECTIVE The objective of this study was to identify and quantify product-related variants in filgrastim reference products and biosimilars thereof that are presently available in highly regulated markets. METHODS In this study, we used intact and top-down mass spectrometry to identify and quantify product-related variants in filgrastim products. Mass spectrometry has become the method of choice for physicochemical characterization of biopharmaceuticals, allowing accurate and sensitive characterization of product-related variants. RESULTS In addition to modifications ubiquitously present in biopharmaceuticals, such as methionine oxidation and asparagine/glutamine deamidation, we identified six different low-level, product-related variants present in some, but not all, of the tested products. Two variants, an acetylated filgrastim variant and a filgrastim variant containing an additional C-terminal tryptophan extension, are newly identified variants. CONCLUSION This study demonstrates that filgrastim products already in widespread clinical use in highly regulated markets differ in low-level, product-related variants present at levels mostly below 1 % relative abundance. This study provides a comprehensive catalog of minor differences between filgrastim products and suggests that the filgrastim product-related variants described here are not clinically relevant when present at low abundance.
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