Filgrastim Agent Is Cost-Effective in NSCLC, According to ASCO Study

For patients with nonmetastatic non—small cell lung cancer (NSCLC) who are at intermediate-risk of developing febrile neutropenia (FN), biosimilar filgrastim (Zarxio) is cost-effective when used as a primary prophylaxis (PP) when a payer’s willingness-to-pay (WTP) threshold is $50,000 per quality-adjusted life-year (QALY) gained, according to a new study.

Findings were presented at ASCO20 Virtual, the annual meeting of the American Society of Clinical Oncology. Patients with nonmetastatic NSCLC are at intermediate risk (10%-20%) of developing FN if they are receiving platinum-based chemotherapy.

Authors said most patients with NSCLC who receive chemotherapy have ≥1 FN risk factors, and although PP can reduce the incidence of FN, it is more costly than secondary prophylaxis (SP).

The study used a Markov statistical model to evaluate PP versus SP to prevent chemotherapy-induced FN in patients 61 years of age receiving adjuvant carboplatin/paclitaxel every 3 weeks for 4 cycles.

Investigators conducted separate analyses for patients with 0 FN risk factors and ≥1 FN risk factors, representing 11.3% and 18% baseline FN risk, respectively. They calculated incremental cost-effectiveness ratios (ICERs) for cost per FN event avoided, life-year saved (LYS), and QALY gained from a United States payer perspective.

Cost-Effectiveness for Patients

Use of filgrastim as PP versus SP provided an additional 0.056 QALYs (0.079 LYS) for patients with 0 risk factors, at an incremental cost of $3266. For cost per FN event avoided, cost per LYS, and cost per QALY gained, the ICERs were $46,815, $41,555, and $58,531, respectively.

For patients with 1 or more risk factors for FN, PP versus SP added 0.090 QALYs (0.127 LYS) at an incremental cost of $1605. For cost per FN event avoided, cost per LYS, and cost per QALY gained, the ICERs were $13,970, $12,644, and $17,805, respectively.

Investigators also conducted deterministic and probabilistic sensitivity analyses, finding that the likelihood of cost-effectiveness at a WTP threshold of $50,000 per QALY gained was 31.7% for patients with 0 risk factors for FN and 96.6% for those with at least 1 FN risk factor.

Reference

Li EC, Mezzio D, Spargo K, Campbell KJ, Lyman GH. Cost-effectiveness of filgrastim-sndz as primary prophylaxis (PP) versus secondary prophylaxis (SP) to prevent chemotherapy-induced febrile neutropenia (FN) in non-small cell lung cancer (NSCLC) patients at intermediate risk. Presented at ASCO20 Virtual; May 30-31, 2020. Abstract e19401