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Clinical, Economic Benefits of Pegfilgrastim Biosimilars as Prophylactic Against Febrile Neutropenia


In patients with intermediate- to high-risk, use of pegfilgrastim biosimilars could optimize management of FN risk.

Use of biosimilar pegfilgrastim as a prophylaxis in patients with cancer and a high risk of chemotherapy-induced neutropenia can save money, according to a study published in Future Oncology.

The researchers used real-world data to assess the cost-effectiveness of using pegfilgrastim vs filgrastim using a Markov model with a lifetime horizon. Febrile neutropenia (FN) results in approximately 60,000 patients with cancer being hospitalized annually and costs an estimated $28,000 per admission in the United States.

While biologics are an important treatment for cancer, they are expensive. “Biosimilar versions of these drugs represent an opportunity to reassess the value of the treatment and consider a change in reimbursement practice and clinical management protocols,” the authors explained. “To date, the approval of biosimilar versions of G-CSFs [granulocyte colony-stimulating factors] has been the most striking example of this effect.”

They created an economic model to assess the cost-effectiveness of primary prophylaxis with pegfilgrastim vs filgrastim for patients at high-risk (> 20% risk) of FN and intermediate-risk (10-20%) of FN. There were 5 strategies: pegfilgrastim biosimilars, pegfilgrastim reference in a prefilled syringe (PFS), pegfilgrastim reference in an on-body injector (OBI), filgrastim biosimilars, and filgrastim reference.

In both the high-risk and intermediate-risk groups, biosimilars for pegfilgrastim and filgrastim outperformed the reference products in quality-adjusted life-years, (QALYs), life-years (LYs), and FN events.

Comparing the 2 biosimilars, the authors found:

  • In the high-risk group, pegfilgrastim had 8.02 QALYs, 9.52 LYs, and 0.73 FN events vs 7.73 QALYs, 9.12 LYs, and 1.16 FN events for filgrastim per patient treated.
  • In the high-risk group, the total cost of pegfilgrastim biosimilar resulted in $5703 savings over filgrastim biosimilar with savings largely driven by reduced FN incidence and a lower cost of inpatient FN management.
  • In the intermediate-risk group, pegfilgrastim had 8.61 QALYs, 10.21 LYs, and 1.02 FN events vs 8.49 QALYs, 10.07 LYs, and 1.21 FN events for filgrastim per patient treated.
  • In the intermediate-risk group, the total cost of pegfilgrastim was $1752 more than filgrastim, primarily driven by the higher cost of pegfilgrastim despite the lower cost of FN management.

In most of the tested scenarios, pegfilgrastim biosimilar was cost-saving over filgrastim biosimilar for the high-risk group. Pegfilgrastim biosimilar remained dominant in most scenarios for the intermediate-risk group.

The benefits of pegfilgrastim biosimilar were substantial at a population level, the authors noted. They provided a scenario of 10.936 patients treated with short-acting G-CSF in a health plan of 1 million members in which switching all patients from filgrastim biosimilar to pegfilgrastim biosimilar “could potentially lead to better clinical outcomes and a total cost saving of approximately USD $13 million.”

They suggested optimizing FN management through the use of a framework that integrates pegfilgrastim biosimilar into routine oncology practice.

One of the limitations mentioned was that most of the real-world settings assessing use of pegfilgrastim vs filgrastim to prevent chemotherapy-induced FN has been in breast cancer, lung cancer, and non-Hodgkin lymphoma, which may limit the generalizability of the findings. In addition, they estimated the effectiveness of G-CSFs to prevent FN in the intermediate-risk group since there were no real-world comparative effectiveness studies of the use of G-CSFs to prevent FN in the intermediate-risk group.

However, the analysis clearly shows clinical and economic benefits to using pegfilgrastim biosimilar in patients with intermediate to high-risk to prevent chemotherapy-induced FN, they wrote.

“The introduction of PEG biosimilar urges a re-evaluation of current treatment guidelines for G-CSF use in neutropenia management,” the authors concluded. “A multidisciplinary effort that involves treating oncologists, nurses, pharmacists and patients is needed to fully release the value of G-CSF biosimilars.”


Cornes P, Kelton J, Liu R, Zaidi O, Stephens J, Yang J. Real-world cost-effectiveness of primary prophylaxis with G-CSF biosimilars in patients at intermediate/high risk of febrile neutropenia. Future Oncol. Published online March 31, 2022. doi:10.2217/fon-2022-0095

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