Dr Ivo Abraham on How Neulasta Onpro Is Impacting the Biosimilars Space

Ivo Abraham, PhD, RN, a professor in the Department of Pharmacy Practice at University of Arizona Health Sciences, talks about the results from his cost-efficiency studies and how Amgen’s Onpro pegfilgrastim device has affected cancer care and costs.

Ivo Abraham, PhD, RN, a professor in the Department of Pharmacy Practice at University of Arizona Health Sciences, discusses the current state of the granulocyte-colony stimulating factor (G-CSF) sector of the biosimilar market. Abraham is also a health care consultant and cofounder at Matrix45.


You recently published 2 cost-efficiency analyses showing the potential savings that could be generated by switching patients from Neulasta Onpro to a biosimilar pegfilgrastim. Could you briefly explain these findings and how they can help inform prescribing decisions?

Well, we started doing these studies over 10 years ago and we're doing it in Europe. We were trying to show that yes, savings should be achieved. That's no rocket science. If something is priced lower than another product, obviously, you're gonna achieve some some efficiencies. But then we also started looking at how can the savings that have been generated be applied to purchase more treatments on a budget-neutral basis. So, let's say, you save a million dollars. Now, you could put that million dollars back into your general account. As a payer, you can either give prophylactics to more patients, [like] G-CSF drugs that prevent febrile neutropenia [FN] and neutropenia generally, or purchase more of the newer cancer treatments.

So, we have done all of these comparisons now. Amgen, and for disclosure reasons [I'll say] we've done work for Amgen over the years, had an ingenious idea with Neulasta Onpro, because it protects the pegfilgrastim franchise that they have, obviously, but it also has a convenience factor. Patients do not have to come back the next day to get this 1 shot of pegfilgrastim. After you apply it, about 27 to 28 hours later, [the Onpro device] administers [the drug]. You don't have to come back for your prophylactics.

Now, one concern that started popping up in the literature and in the cancer community is that it's a device and devices occasionally fail. There have been reports of between 1.9% and 6.7% of devices are failing. The consequence of that is that suddenly a patient who [should be] receiving a prophylactic and knows that they have a highly myelotoxic chemotherapy regimen may no longer be getting the prophylactic. That triggers a whole cascade. If they are not receiving that prophylactic and are at risk for FN, they now are at a higher risk of FN, which may lead in turn to hospitalization.

A large proportion, probably the majority of FN cases, especially with older patients or patients with very advanced cancer and have very toxic chemotherapy regimens, will end up being hospitalized. The cost estimate of hospitalization in today's terms is probably somewhere between $30,000 and $35,000. So, suddenly as a payer, you have to add another $35,000 to managing this particular patient.

Now, there is an alarm function on the device in case it malfunctions but [concerns] remain. Patients may have been educated about the risks of the device failure, but imagine being a patient with cancer. There's only so much you can hear on the day of chemotherapy. So, here the first time they're applying it and the nurse or pharmacist may tell you, "Yeah, there is something in it if it goes bad, but still, it may happen." So, we need to take into account the risks and the additional costs because if you have to pay more as a payer, there's going to be less money for something else.